Provider Demographics
NPI:1013553775
Name:LILLARD, NETTIE MARIE
Entity Type:Individual
Prefix:DR
First Name:NETTIE
Middle Name:MARIE
Last Name:LILLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 RIGSBY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78222-1014
Mailing Address - Country:US
Mailing Address - Phone:210-639-4641
Mailing Address - Fax:
Practice Address - Street 1:2419 RIGSBY AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78222-1014
Practice Address - Country:US
Practice Address - Phone:210-639-4641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral