Healthcare Provider Details

I. General information

NPI: 1033205125
Provider Name (Legal Business Name): RICHARD P LILLARD PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 04/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 W TRUMAN BLVD STE 101
JEFFERSON CITY MO
65109-5861
US

IV. Provider business mailing address

3401 W TRUMAN BLVD STE 100
JEFFERSON CITY MO
65109-5752
US

V. Phone/Fax

Practice location:
  • Phone: 573-864-7868
  • Fax:
Mailing address:
  • Phone: 573-644-7909
  • Fax: 573-644-7908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2006033324
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: