Healthcare Provider Details

I. General information

NPI: 1548330079
Provider Name (Legal Business Name): CALLIE J LILES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8222 DOUGLAS AVE SUITE 390
DALLAS TX
75225-5923
US

IV. Provider business mailing address

8222 DOUGLAS AVE SUITE 390
DALLAS TX
75225-5923
US

V. Phone/Fax

Practice location:
  • Phone: 214-234-2411
  • Fax: 214-234-2401
Mailing address:
  • Phone: 214-234-2411
  • Fax: 214-234-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29867
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: