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General NPI Number Information
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NPI Number | 1861442444
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Entity Type | Individual
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Provider Name | LILA MAE PRIDE L.M.S.W.
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Gender | Female
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4625 BECKLEY RD BLDG 100
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City | BATTLE CREEK
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State | MI
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Zip | 49015-7948
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Country | US
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Telephone | 269-979-8490
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Fax | 269-979-8492
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Provider Business Mailing Address
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Address Line | 8883 TAMARISK CIR
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City | RICHLAND
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State | MI
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Zip | 49083-8607
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Country | US
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Telephone | 269-629-4443
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 6801084422
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License Number State | MI
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