MEDICARE: MS. JULIE A LILLIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH14558	FL

General Provider Information

NPI Number	:	1215104542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIE A LILLIS

Provider Business Mailing Address
First Line	:	712 MANATEE BAY DR
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33435-2821
Country	:	US
Telephone Number	:	561-307-3703
Fax Number	:

Provider Business Practice Location Address
First Line	:	1375 GATEWAY BLVD STE 32
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-8304
Country	:	US
Telephone Number	:	561-307-3703
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	08/20/2019

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