Provider Demographics
NPI:1609307479
Name:LILLARD, JOHN (PLPC, LAC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LILLARD
Suffix:
Gender:M
Credentials:PLPC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 N SALCEDO ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-4023
Mailing Address - Country:US
Mailing Address - Phone:504-535-4716
Mailing Address - Fax:
Practice Address - Street 1:3801 CANAL ST
Practice Address - Street 2:SUITE 220
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6082
Practice Address - Country:US
Practice Address - Phone:504-482-2735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6463101Y00000X
LA1588101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)