IndividualActive
Jerry Lilly, ED.S
NPI 1124390786 · Professional Counselor · Eagle, ID
Provider details
- NPI number
- 1124390786
- Entity type
- Individual
- Primary specialty
- Professional CounselorBehavioral Health & Social Service Providers
- Credential
- ED.S
- Sex
- Male
- Sole proprietor
- Yes
- License
- LCPC-6990 (ID)
Specialties & taxonomies
Behavioral Health & Social Service Providers
Profile Score
Detailed profile(85/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
14 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
2 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
172 S Academy Ave Ste 160
Eagle, ID 83616-6564
Phone: (208) 315-4855
Street-level locationGet directions
Mailing address
12073 N Humphreys Way
Boise, ID 83714-9343
Additional practice locations (1)
- 12073 N Humphreys WayBoise, ID 83714-9343Phone: (208) 315-4855
Registry dates
- Enumerated
- 2012-01-29
- Last updated
- 2025-09-11
- Certified
- 2023-07-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.