Provider Demographics
NPI:1447261193
Name:LILLAK, DALE KAY (MFT)
Entity type:Individual
Prefix:
First Name:DALE
Middle Name:KAY
Last Name:LILLAK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2391 THE ALAMEDA
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-6011
Mailing Address - Country:US
Mailing Address - Phone:408-260-9995
Mailing Address - Fax:408-246-1050
Practice Address - Street 1:2391 THE ALAMEDA
Practice Address - Street 2:SUITE 110
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-6011
Practice Address - Country:US
Practice Address - Phone:408-260-9995
Practice Address - Fax:408-246-1050
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 29618101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health