Provider Demographics
NPI:1598231961
Name:LILLY COUNSELING AND CONSULTATION LLC
Entity Type:Organization
Organization Name:LILLY COUNSELING AND CONSULTATION LLC
Other - Org Name:9-1-1 RECOVERS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER, PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:LILLY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:734-274-0870
Mailing Address - Street 1:2S504 ASHLEY DR
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137
Mailing Address - Country:US
Mailing Address - Phone:734-274-0870
Mailing Address - Fax:
Practice Address - Street 1:2S504 ASHLEY DR
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137
Practice Address - Country:US
Practice Address - Phone:734-274-0870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-23
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL071.007793OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION