Provider Demographics
NPI:1689945974
Name:LILLY-MOLLOY, JEANNE MARJORIE (MS - MFCT)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:MARJORIE
Last Name:LILLY-MOLLOY
Suffix:
Gender:F
Credentials:MS - MFCT
Other - Prefix:MISS
Other - First Name:JEANNE
Other - Middle Name:MARJORIE
Other - Last Name:LILLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1180 SELMI DR STE 201
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-4776
Mailing Address - Country:US
Mailing Address - Phone:775-741-2719
Mailing Address - Fax:775-849-0281
Practice Address - Street 1:1180 SELMI DR STE 201
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-4776
Practice Address - Country:US
Practice Address - Phone:775-741-2719
Practice Address - Fax:775-849-0281
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI0482106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist