Provider Demographics
NPI:1407086374
Name:LILLARD, IVETT (PHD)
Entity Type:Individual
Prefix:DR
First Name:IVETT
Middle Name:
Last Name:LILLARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2656 RIDEOUT LN
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37128-7607
Mailing Address - Country:US
Mailing Address - Phone:615-895-0710
Mailing Address - Fax:
Practice Address - Street 1:2656 RIDEOUT LN
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37128-7607
Practice Address - Country:US
Practice Address - Phone:615-895-0710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-24
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004013645101YP2500X
TN3359101YP2500X
TN3653103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional