Susan Lilledahl, SUSAN LILLEDAHL MFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

MC34555 Issued in CA

Practice address

129 La Goma St
Mill Valley, CA 94941-9494

Phone

(415) 381-6453

NPI assigned

Jan 2, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1528125531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 LA GOMA ST",
            "city": "MILL VALLEY",
            "state": "CA",
            "postal_code": "949412110",
            "telephone_number": "415-381-6453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 LA GOMA ST",
            "city": "MILL VALLEY",
            "state": "CA",
            "postal_code": "949419494",
            "telephone_number": "415-381-6453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LILLEDAHL",
        "first_name": "SUSAN",
        "credential": "SUSAN LILLEDAHL MFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-02",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "MC34555",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Mill Valley, CA
• Providers in Mill Valley, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.