Provider Demographics
NPI:1457111668
Name:MOODY, LILLIANNE CHRISTINE (CLC)
Entity Type:Individual
Prefix:MRS
First Name:LILLIANNE
Middle Name:CHRISTINE
Last Name:MOODY
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4051 N SUPERSTITION CT
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-7630
Mailing Address - Country:US
Mailing Address - Phone:928-830-1642
Mailing Address - Fax:
Practice Address - Street 1:4051 N SUPERSTITION CT
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-7630
Practice Address - Country:US
Practice Address - Phone:928-830-1642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ348436174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN