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General NPI Number Information
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NPI Number | 1831967652
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Entity Type | Individual
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Provider Name | ERIC JAMES LILES LPCA
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Gender | Male
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Dates
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Enumeration Date | 12/12/2023
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Last Update Date | 12/12/2023
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Provider Practice Location Address
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Address Line | 3600 SHIRE BLVD STE 208
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City | RICHARDSON
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State | TX
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Zip | 75082-2238
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Country | US
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Telephone | 214-556-0996
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Fax |
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Provider Business Mailing Address
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Address Line | 6605 BEVINGTON RD
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City | DALLAS
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State | TX
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Zip | 75248-1409
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Country | US
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Telephone | 434-989-8801
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 93439
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License Number State | TX
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