Individual
CARLY RENEE LILLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2235 E FLAMINGO RD STE 234, LAS VEGAS, NV 89119-5197
(702) 331-5608
Mailing address
2235 E FLAMINGO RD STE 234, LAS VEGAS, NV 89119-5197
(702) 331-5608
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/23/2017
Last updated
09/15/2022
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