Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 2006033324 | MO |
Y | 103TC0700X | Clinical Psychologist | 2006033324 | MO |
N | 103TC1900X | Counseling Psychologist | MO |
NPI | 1033205125 |
---|---|
Provider Name | Dr. Richard P Lillard |
First Address | Jefferson City, MO 65109-5752 |
Second Address | Jefferson City, MO 65109-5861 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 29/04/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
497174508 | (05) | MO |