Individual
MS. BIANCA LILLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, BCBA, LBA
Contact information
Practice address
226 W PRIEN LAKE RD STE 3, LAKE CHARLES, LA 70601-8781
(337) 882-2100
(337) 882-2111
Mailing address
PO BOX 1169, LAKE CHARLES, LA 70602
(337) 882-2100
(337) 882-2111
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
11725428
TX
103K00000X
Behavior Analyst
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2459112
—
LA
Enumeration date
04/14/2017
Last updated
09/09/2021
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