Individual
DR. ANTHONY EZRA LILLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D., H.S.P.P.
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
103T00000X
Psychologist
Primary
20042033A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050571023
FED TAX IDENTIFICATION
IN
05
—
200805260A
—
IN
Enumeration date
08/18/2006
Last updated
07/01/2014
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