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Organization

GREENBRIER PROFESSIONALS, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ANTHONY E LILLY PSY.D., HSPP (OWNER)
(812) 346-7744
Entity
Organization

Contact information

Practice address
753 N STATE ST, NORTH VERNON, IN 47265-1044
(812) 346-7744
(812) 346-3815
Mailing address
753 N STATE ST, NORTH VERNON, IN 47265-1044
(812) 346-7744
(812) 346-3815

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
103TC0700X
Clinical Psychologist
Primary
20042033A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200805260A
IN
Enumeration date
03/08/2007
Last updated
07/01/2014
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