Provider Demographics
NPI:1821326133
Name:FARELL-LILLA, CHRISTINE T (MA LPC)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:T
Last Name:FARELL-LILLA
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 HANLEY RD
Mailing Address - Street 2:STE. F
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-8705
Mailing Address - Country:US
Mailing Address - Phone:715-381-1980
Mailing Address - Fax:651-381-1906
Practice Address - Street 1:2501 HANLEY RD
Practice Address - Street 2:STE. F
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-8705
Practice Address - Country:US
Practice Address - Phone:715-381-1980
Practice Address - Fax:651-381-1906
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3620-125101YP2500X
MNLPC00605101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional