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Individual

DR. KELLY DAWN LILL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PHD, LMHC

Contact information

Practice address
2000 PREVATT ST, SUITE B, EUSTIS, FL 32726-6149
(352) 589-0622
(352) 589-0276
Mailing address
13301 CASA VERDE CIR, ASTATULA, FL 34705-9393
(352) 742-1346

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
101YM0800X
Mental Health Counselor
MH 7165
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
767316700
FL
Enumeration date
07/14/2006
Last updated
05/11/2022
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