Provider Demographics
NPI:1275353419
Name:LILIE, BEVERLY (MA, LPC - ASSOCIATE)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:LILIE
Suffix:
Gender:F
Credentials:MA, LPC - ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 COUNTY ROAD 208
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:TX
Mailing Address - Zip Code:77836-5226
Mailing Address - Country:US
Mailing Address - Phone:979-406-0464
Mailing Address - Fax:
Practice Address - Street 1:121 S MAIN ST STE CALDWELL
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:TX
Practice Address - Zip Code:77836-1741
Practice Address - Country:US
Practice Address - Phone:979-406-0464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93107101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional