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General NPI Number Information
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NPI Number | 1033359435
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Entity Type | Organization
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Legal Business Name | LILES COUNSELING PROFESSIONAL LIMITED LIABILITY COMPANY
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Dates
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Enumeration Date | 02/24/2009
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Last Update Date | 02/24/2009
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Provider Practice Location Address
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Address Line | 1000 W STATE HIGHWAY 6
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City | WOODWAY
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State | TX
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Zip | 76712-3786
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Country | US
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Telephone | 254-776-0001
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Fax |
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Provider Business Mailing Address
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Address Line | 10486 BURGESS RD
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City | TEMPLE
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State | TX
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Zip | 76501-7371
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Country | US
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Telephone | 254-624-6755
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | MR. JAMES AYDEN LILES
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Credential | LPC
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Telephone | 254-624-6755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 63247
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License Number State | TX
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