Provider Demographics
NPI:1093594301
Name:LILLY, PEBBLES TOWAN (PLPC)
Entity Type:Individual
Prefix:
First Name:PEBBLES
Middle Name:TOWAN
Last Name:LILLY
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 EDENBORN AVE APT 215A
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-7559
Mailing Address - Country:US
Mailing Address - Phone:225-362-1884
Mailing Address - Fax:
Practice Address - Street 1:3040 TEDDY DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-1925
Practice Address - Country:US
Practice Address - Phone:225-218-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-26
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator