Healthcare Provider Details

I. General information

NPI: 1255547816
Provider Name (Legal Business Name): TANYA M LILLY MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 N HIGH ST
COLUMBUS OH
43215-1430
US

IV. Provider business mailing address

131 BURKHOLDER ST
OAK HILL WV
25901-2401
US

V. Phone/Fax

Practice location:
  • Phone: 866-280-0260
  • Fax:
Mailing address:
  • Phone: 304-890-7573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2607934
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00942563
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: