| NPI | 1912460106 |
|---|---|
| Former Name | LILLY TEACHOUT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 261QM0855X Clinic/Center, Adolescent and Children Mental Health (Licence: MI 6851118260) |
| Enumeration Date | 2019-04-13 |
| Last Update Date | 2026-08-07 |