Provider Demographics
NPI:1013589753
Name:WHITE, LILLY K (LCSW)
Entity Type:Individual
Prefix:
First Name:LILLY
Middle Name:K
Last Name:WHITE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LILLY
Other - Middle Name:K
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9438 HIGHWAY C
Mailing Address - Street 2:
Mailing Address - City:HUNNEWELL
Mailing Address - State:MO
Mailing Address - Zip Code:63443-3038
Mailing Address - Country:US
Mailing Address - Phone:217-320-3249
Mailing Address - Fax:
Practice Address - Street 1:100 W MAPLE ST
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:MO
Practice Address - Zip Code:63437-1728
Practice Address - Country:US
Practice Address - Phone:573-494-2280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220412841041C0700X
IL149.0232871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical