Provider Demographics
NPI:1992368591
Name:HA, LILY M (BCBA)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:M
Last Name:HA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2338 W ROYAL PALM RD STE J
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-9339
Mailing Address - Country:US
Mailing Address - Phone:855-772-8847
Mailing Address - Fax:
Practice Address - Street 1:2338 W ROYAL PALM RD STE J
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-9339
Practice Address - Country:US
Practice Address - Phone:855-772-8847
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX11935118103G00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist