Provider Demographics
NPI:1447142369
Name:THIBOUTOT, LILY (BCBA)
Entity type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:THIBOUTOT
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 DANIELLE LN
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19320-2788
Mailing Address - Country:US
Mailing Address - Phone:302-530-0951
Mailing Address - Fax:
Practice Address - Street 1:205 DANIELLE LN
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-2788
Practice Address - Country:US
Practice Address - Phone:302-530-0951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-20-44463103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst