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General NPI Number Information
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NPI Number | 1588922140
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Entity Type | Individual
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Provider Name | DONALD AMOS LILLEY LMFT
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Gender | Male
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Dates
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Enumeration Date | 05/01/2012
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Last Update Date | 05/01/2012
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Provider Practice Location Address
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Address Line | 1800 TULLY RD SUITE F
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City | MODESTO
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State | CA
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Zip | 95350-2946
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Country | US
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Telephone | 209-576-1750
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Fax |
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Provider Business Mailing Address
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Address Line | 12414 MILLS ST
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City | GROVELAND
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State | CA
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Zip | 95321-9322
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Country | US
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Telephone | 209-962-6540
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | LMFT 19577
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License Number State | CA
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