Provider Demographics
NPI:1538119748
Name:LILL, DIANE (LMHC)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:LILL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2484 FAIRFAX CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-4424
Mailing Address - Country:US
Mailing Address - Phone:317-605-9111
Mailing Address - Fax:
Practice Address - Street 1:618 8TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-6861
Practice Address - Country:US
Practice Address - Phone:317-605-9111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39001761101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000830060OtherANTHEM BCBS
IN000000827959OtherANTHEM BCBS
IN000000835164OtherANHTHEM BCBS