Individual
DR. JEANNE MARIAH LILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
785 OHIO AVE STE 3E, CLARKSDALE, MS 38614-6215
(662) 351-0702
(662) 351-0703
Mailing address
785 OHIO AVE STE 3E, CLARKSDALE, MS 38614-6215
(662) 351-0702
(662) 351-0703
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
621115
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200010527
—
MS
Enumeration date
12/29/2023
Last updated
08/07/2024
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