1235351081 NPI number — MR. PETER LAWRENCE HILLIARD LCSW

Table of content: MR. PETER LAWRENCE HILLIARD LCSW (NPI 1235351081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235351081 NPI number — MR. PETER LAWRENCE HILLIARD LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILLIARD
Provider First Name:
PETER
Provider Middle Name:
LAWRENCE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235351081
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24117 OLD COUNTRY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORENO VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92557-4003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-242-3709
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13800 HEACOCK ST
Provider Second Line Business Practice Location Address:
SUITE 133
Provider Business Practice Location Address City Name:
MORENO VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92553-3339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-656-7318
Provider Business Practice Location Address Fax Number:
951-656-3269
Provider Enumeration Date:
05/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS 7475 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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