=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356562524
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICK ANTHONY LILLY LPC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 616 N MAIN ST
-----------------------------------------------------
City | TEMPLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76501-3249
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-624-7215
-----------------------------------------------------
Fax | 254-778-7745
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4009 HOPI TRL
-----------------------------------------------------
City | TEMPLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76504-4933
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-624-7215
-----------------------------------------------------
Fax | 254-778-7745
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 19287
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------