Provider Demographics
NPI:1962893040
Name:KIRKLAND, LILY NGUYEN (MA)
Entity type:Individual
Prefix:MRS
First Name:LILY
Middle Name:NGUYEN
Last Name:KIRKLAND
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 CITY BLVD WEST
Mailing Address - Street 2:APT. 214
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:714-943-4385
Mailing Address - Fax:
Practice Address - Street 1:170 CITY BLVD W
Practice Address - Street 2:APT. 214
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2960
Practice Address - Country:US
Practice Address - Phone:714-943-4385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-11
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 68556106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist