Provider Demographics
NPI:1336301621
Name:LILJA, SHANNON M (DBH LPC LMHC SUD CAD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:M
Last Name:LILJA
Suffix:
Gender:F
Credentials:DBH LPC LMHC SUD CAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1866
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98668-1866
Mailing Address - Country:US
Mailing Address - Phone:503-260-5118
Mailing Address - Fax:
Practice Address - Street 1:752 OFFICERS ROW
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-3845
Practice Address - Country:US
Practice Address - Phone:503-260-5118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60166285101YA0400X
OR12-R-25101YA0400X
ORC2687101YM0800X, 101YP2500X
WALH60129047101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional