Provider Demographics
NPI:1669598017
Name:LILLEY, RHONDA J (PHD)
Entity type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:J
Last Name:LILLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8963 MACINTYRE DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-8543
Mailing Address - Country:US
Mailing Address - Phone:614-764-9791
Mailing Address - Fax:614-764-1392
Practice Address - Street 1:1550 OLD HENDERSON RD STE E212
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-3652
Practice Address - Country:US
Practice Address - Phone:614-947-0936
Practice Address - Fax:614-947-0937
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4480103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0867709Medicaid
OHCP10782Medicare ID - Type Unspecified
OH0867709Medicaid