Provider Demographics
NPI:1730462201
Name:LILLER, TERRI (MSW, LISW-S, LICDC)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:
Last Name:LILLER
Suffix:
Gender:F
Credentials:MSW, LISW-S, LICDC
Other - Prefix:
Other - First Name:TENLEY
Other - Middle Name:L
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW,LISW-S,LICDC
Mailing Address - Street 1:7 COURT ST STE 260
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-1407
Mailing Address - Country:US
Mailing Address - Phone:330-333-9559
Mailing Address - Fax:414-234-0069
Practice Address - Street 1:7 COURT ST STE 260
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-1407
Practice Address - Country:US
Practice Address - Phone:330-333-9559
Practice Address - Fax:414-234-0069
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161011101YA0400X
OHI1303604-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0157389Medicaid
OHH033323Medicare PIN