Provider Demographics
NPI:1467625335
Name:LILLEGARD, VICKI MARIA (MA, LACADC, LMFT)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:MARIA
Last Name:LILLEGARD
Suffix:
Gender:F
Credentials:MA, LACADC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5187 ORINDA DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-3615
Mailing Address - Country:US
Mailing Address - Phone:775-626-8245
Mailing Address - Fax:
Practice Address - Street 1:PYRAMID LAKE TRIBAL HEALTH CLINIC
Practice Address - Street 2:705 HIGHWAY 446
Practice Address - City:NIXON
Practice Address - State:NV
Practice Address - Zip Code:89424-8942
Practice Address - Country:US
Practice Address - Phone:775-574-1018
Practice Address - Fax:775-574-1028
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00577-LC101YA0400X
NV2704106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)