Healthcare Provider Details

I. General information

NPI: 1881730927
Provider Name (Legal Business Name): BART E LILES LPC LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4155 HIGHWAY 8
POLLOCK LA
71467-3949
US

IV. Provider business mailing address

PO BOX 9
QUITMAN LA
71268-0009
US

V. Phone/Fax

Practice location:
  • Phone: 318-439-1399
  • Fax: 855-334-8166
Mailing address:
  • Phone: 318-439-1399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number198
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number92608
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2361
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: