Provider Demographics
NPI:1881622439
Name:KAROUB, LILA M (MFT)
Entity type:Individual
Prefix:MS
First Name:LILA
Middle Name:M
Last Name:KAROUB
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 1:2220 DEL MAR HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-3022
Mailing Address - Country:US
Mailing Address - Phone:619-807-5550
Mailing Address - Fax:760-742-2356
Practice Address - Street 1:2220 DEL MAR HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3022
Practice Address - Country:US
Practice Address - Phone:619-807-5550
Practice Address - Fax:760-742-2356
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT36460106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist