Provider Demographics
NPI:1972781789
Name:LILLEYMAN, BARBARA ANN (MA,LLP)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:LILLEYMAN
Suffix:
Gender:F
Credentials:MA,LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8836 SANDYCREST CT
Mailing Address - Street 2:
Mailing Address - City:WHITE LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48386-2449
Mailing Address - Country:US
Mailing Address - Phone:248-698-2207
Mailing Address - Fax:
Practice Address - Street 1:424 W 5TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-2545
Practice Address - Country:US
Practice Address - Phone:248-548-8046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007330103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist