Individual
JERRY DUANE LILLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ED.S
Contact information
Practice address
172 S ACADEMY AVE STE 160, EAGLE, ID 83616-6564
(208) 315-4855
Mailing address
12073 N HUMPHREYS WAY, BOISE, ID 83714-9343
(208) 315-4855
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LCPC-6990
ID
Other
Enumeration date
01/29/2012
Last updated
09/11/2025
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