| Lillac Counseling Services, Llc | |
|
3130 W Discovery Loop Wasilla AK 99654-1283 | |
| (907) 866-2108 | |
| Not Available |
| Full Name | Lillac Counseling Services, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3130 W Discovery Loop, Wasilla, Alaska |
| Authorized Official Name and Position | Victoria Miller (REGISTERED AGENT) |
| Authorized Official Contact | 2513153474 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lillac Counseling Services, Llc Po Box 874252 Wasilla AK 99687-4252 Ph: (866) 210-8282 | Lillac Counseling Services, Llc 3130 W Discovery Loop Wasilla AK 99654-1283 Ph: (907) 866-2108 |
| NPI Number | 1952036824 |
|---|---|
| Provider Enumeration Date | 07/23/2022 |
| Last Update Date | 05/13/2023 |
| Certification Date | 05/13/2023 |
| Medicare PECOS PAC ID | 1456795210 |
|---|---|
| Medicare Enrollment ID | O20240220002564 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952036824 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Victoria Jolene Miller |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1144485194 PECOS PAC ID: 3274977038 Enrollment ID: I20240220002823 |
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