Healthcare Provider Details

I. General information

NPI: 1508196973
Provider Name (Legal Business Name): SHAWN R. LILLY LPC, MHSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2010
Last Update Date: 01/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W SMITH ST
GALLATIN TN
37066-3246
US

IV. Provider business mailing address

101 TUTTLE LN
BETHPAGE TN
37022-8514
US

V. Phone/Fax

Practice location:
  • Phone: 615-451-2169
  • Fax:
Mailing address:
  • Phone: 615-841-3506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2136
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: