Individual
MR. THOMAS LILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSW/LICSW
Contact information
Practice address
39 SHORTCUT ROAD, INCHELIUM, WA 99138
(509) 722-7006
Mailing address
PO BOX 290, INCHELIUM, WA 99138-0290
(509) 722-7006
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LW00004159
WA
1041C0700X
Clinical Social Worker
LW00004159
WA
Other
Enumeration date
06/10/2020
Last updated
07/29/2020
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