Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | 15529 | MD |
Y | 1041C0700X | Clinical Social Worker | 56962 | TX |
N | 1041C0700X | Clinical Social Worker | LC50078619 | DC |
NPI | 1003133992 |
---|---|
Provider Name | Mrs. Lilian Inutu Bollers |
First Address | Plano, TX 75025-5909 |
Second Address | Plano, TX 75025-5909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2010 |
Last Update Date | 10/07/2015 |