Individual provider Active NPI

Heather Lilleston, PH.D.

  • Psychologist
  • Venice, CA
National Provider Identifier
1972484475
Registry record updated Sep 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
94027314 Issued in CA
Practice address
228 Main St Ste 2
Venice, CA 90291-5235
Phone
(310) 741-7408
NPI assigned
Sep 10, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 94027314 CA Primary

Addresses

Primary practice location

228 Main St Ste 2
Venice, CA 90291-5235

Mailing address

203 Flamingo Rd # 208
Mill Valley, CA 94941-3603
Phone (917) 833-3231

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
94027314CAMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Mindset la Assessments LLC Psychologist CurrentSince Sep 14, 2025 Accepting new patients

Locations

228 Main St
Ste 2
Venice, CA 90291
Phone (310) 741-7408

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1757462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757462400000",
    "number": "1972484475",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 FLAMINGO RD # 208",
            "city": "MILL VALLEY",
            "state": "CA",
            "postal_code": "949413603",
            "telephone_number": "917-833-3231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "228 MAIN ST STE 2",
            "city": "VENICE",
            "state": "CA",
            "postal_code": "902915235",
            "telephone_number": "310-741-7408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LILLESTON",
        "first_name": "HEATHER",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-09-10",
        "last_updated": "2025-09-10",
        "certification_date": "2025-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "94027314",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Venice, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2025; 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.