Healthcare Provider Details

I. General information

NPI: 1417393836
Provider Name (Legal Business Name): LILYFIELD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2013
Last Update Date: 04/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E 15TH ST STE. 400A
EDMOND OK
73013-5043
US

IV. Provider business mailing address

501 E 15TH ST STE. 400A
EDMOND OK
73013-5043
US

V. Phone/Fax

Practice location:
  • Phone: 405-216-5240
  • Fax: 405-285-0294
Mailing address:
  • Phone: 405-216-5240
  • Fax: 405-285-0294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253J00000X
TaxonomyFoster Care Agency
License NumberK860000182
License Number StateOK

VIII. Authorized Official

Name: MRS. HOLLY S TOWERS
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 405-216-5240