Provider Demographics
NPI:1114955465
Name:LITTLE, LILLY (LCSW)
Entity Type:Individual
Prefix:
First Name:LILLY
Middle Name:
Last Name:LITTLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 972355
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79997-2355
Mailing Address - Country:US
Mailing Address - Phone:915-449-1549
Mailing Address - Fax:877-606-9254
Practice Address - Street 1:2150 TRAWOOD DR BLDG B
Practice Address - Street 2:SUITE 252
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-3322
Practice Address - Country:US
Practice Address - Phone:915-449-1549
Practice Address - Fax:877-606-9254
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX05381101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0060MROtherBCBS
TX149445201Medicaid