Provider Demographics
NPI:1972877793
Name:LILES, HEATHER ANN
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:ANN
Last Name:LILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 ROLLINGSFORD CIR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-3866
Mailing Address - Country:US
Mailing Address - Phone:702-527-9775
Mailing Address - Fax:
Practice Address - Street 1:3925 ROLLINGSFORD CIR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-3866
Practice Address - Country:US
Practice Address - Phone:702-527-9775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-24
Last Update Date:2017-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst