Provider Demographics
NPI:1649817529
Name:MILECKY, LILLY
Entity type:Individual
Prefix:
First Name:LILLY
Middle Name:
Last Name:MILECKY
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:LILLY
Other - Middle Name:MARIE-RUTH
Other - Last Name:MILECKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RBT
Mailing Address - Street 1:7628 S SONCY RD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6762
Mailing Address - Country:US
Mailing Address - Phone:806-654-3596
Mailing Address - Fax:
Practice Address - Street 1:6031 BELL ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-6618
Practice Address - Country:US
Practice Address - Phone:806-367-9358
Practice Address - Fax:806-500-2772
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1992580106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty