| Organization Name: | SANDY LILLIE, PH.D. |
| NPI Number: | 1558793406 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SANDRA LEE LILLIE (OWNER) |
| Mailing Address: | 102 Vaquero Way Emerald Hills |
| State: | CA US |
| Postal Code: | 940623152 |
| Phone Number: | 6503685802 |
| Fax Number: | 6505689800 |
| NPI Enumeration Date: | 08/02/2013 |
| NPI Last Update Date: | 08/02/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY8872 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |