Provider Demographics
NPI:1497010839
Name:HILLIARD, ANGELA LOUISE
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:LOUISE
Last Name:HILLIARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IL
Mailing Address - Zip Code:61727-1817
Mailing Address - Country:US
Mailing Address - Phone:405-694-8953
Mailing Address - Fax:
Practice Address - Street 1:200 E MAIN ST
Practice Address - Street 2:LIFEWAY BEHAVIORAL HEALTH SERVICES INC
Practice Address - City:CLINTON
Practice Address - State:IL
Practice Address - Zip Code:61727-3001
Practice Address - Country:US
Practice Address - Phone:217-935-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-11
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor