Provider Demographics
NPI:1356804793
Name:LILLY, ANGELA MARIE (LPC)
Entity type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:MARIE
Last Name:LILLY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:ANGELA
Other - Middle Name:
Other - Last Name:LILLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANGELA M LILLY LPC
Mailing Address - Street 1:7211 STANDARD RD
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-3060
Mailing Address - Country:US
Mailing Address - Phone:713-504-1473
Mailing Address - Fax:
Practice Address - Street 1:7211 STANDARD RD
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-3060
Practice Address - Country:US
Practice Address - Phone:281-315-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-11
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77700101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty