Provider Demographics
NPI:1720433196
Name:FARRIS, LILLIAN (DNP, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:FARRIS
Suffix:
Gender:F
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 S 2300 E STE 102
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4682
Mailing Address - Country:US
Mailing Address - Phone:385-313-0401
Mailing Address - Fax:385-313-9762
Practice Address - Street 1:4525 S 2300 E STE 102
Practice Address - Street 2:
Practice Address - City:HOLLADAY
Practice Address - State:UT
Practice Address - Zip Code:84117-4682
Practice Address - Country:US
Practice Address - Phone:385-313-0401
Practice Address - Fax:385-313-9762
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9130549-4405363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health