Provider Demographics
NPI:1902995913
Name:ESCOBAR-THIES, LILIANA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LILIANA
Middle Name:
Last Name:ESCOBAR-THIES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1254 2ND ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:LOS OSOS
Mailing Address - State:CA
Mailing Address - Zip Code:93402-1110
Mailing Address - Country:US
Mailing Address - Phone:805-215-3518
Mailing Address - Fax:
Practice Address - Street 1:1254 2ND ST
Practice Address - Street 2:SUITE C
Practice Address - City:LOS OSOS
Practice Address - State:CA
Practice Address - Zip Code:93402-1110
Practice Address - Country:US
Practice Address - Phone:805-215-3518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20800103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical