Healthcare Provider Details

I. General information

NPI: 1093524878
Provider Name (Legal Business Name): LILYPAD THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 SIMMONS ST
ERIE CO
80516-7201
US

IV. Provider business mailing address

361 SIMMONS ST
ERIE CO
80516-7201
US

V. Phone/Fax

Practice location:
  • Phone: 817-996-5664
  • Fax: 817-927-7578
Mailing address:
  • Phone: 817-996-5664
  • Fax: 817-927-7578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANET M BROWN
Title or Position: OWNER
Credential: LCSW
Phone: 817-996-5664