Doctor Name: | DR. KELLY DAWN LILL |
NPI Number: | 1215953096 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD, LMHC |
License Number: | MH 7165 |
Business Practice Address: | 2000 Prevatt St Suite B Eustis, FL - 327266149 |
Business Phone Number: | 3525890622 |
Business Fax Number: | 3525890276 |
Mailing Address: | 13301 Casa Verde Cir, ASTATULA |
State: | FL |
Postal Code: | 347059393 |
Phone Number: | 3527421346 |
Fax Number: | |
NPI Enumeration Date: | 07/14/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | MH 7165 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |