Provider Demographics
NPI:1396761847
Name:HILLAS, LYNN A (LISW)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:A
Last Name:HILLAS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 ANDERSON PL SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-4406
Mailing Address - Country:US
Mailing Address - Phone:505-268-5633
Mailing Address - Fax:
Practice Address - Street 1:404 SAN MATEO BLVD NE
Practice Address - Street 2:SUITE 12
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-5547
Practice Address - Country:US
Practice Address - Phone:505-925-4052
Practice Address - Fax:505-925-4055
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-04908101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM36137511Medicaid