Provider Demographics
NPI:1154554798
Name:LILLIE, CORRIE A (LMFT)
Entity type:Individual
Prefix:MRS
First Name:CORRIE
Middle Name:A
Last Name:LILLIE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 ROSANNE ST
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73703-3530
Mailing Address - Country:US
Mailing Address - Phone:580-234-0411
Mailing Address - Fax:
Practice Address - Street 1:5613 N OAKWOOD RD
Practice Address - Street 2:SUITE 3
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-9345
Practice Address - Country:US
Practice Address - Phone:580-747-3630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist