Provider Demographics
NPI:1174239636
Name:DRLULLABY LLC
Entity type:Organization
Organization Name:DRLULLABY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MEDALIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-475-3379
Mailing Address - Street 1:1101 DAVIS ST STE 5767
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-5945
Mailing Address - Country:US
Mailing Address - Phone:844-475-3379
Mailing Address - Fax:855-644-2981
Practice Address - Street 1:4533 MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2059
Practice Address - Country:US
Practice Address - Phone:844-475-3379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DRLULLABY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-27
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty