Healthcare Provider Details

I. General information

NPI: 1003756248
Provider Name (Legal Business Name): LILY COURTNEY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 AVENIDA PONDEROSA
GLORIETA NM
87535
US

IV. Provider business mailing address

PO BOX 515
GLORIETA NM
87535-0515
US

V. Phone/Fax

Practice location:
  • Phone: 512-415-5333
  • Fax:
Mailing address:
  • Phone: 512-415-5333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: LILY COURTNEY
Title or Position: OWNER
Credential: LPC/LPCC
Phone: 512-415-5333