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General NPI Number Information
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NPI Number | 1932463064
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Entity Type | Individual
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Provider Name | EARL GRADY YARBROUGH JR. LPC
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Gender | Male
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Dates
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Enumeration Date | 07/04/2012
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Last Update Date | 07/04/2012
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Provider Practice Location Address
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Address Line | 1499 S MAIN ST
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City | BOERNE
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State | TX
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Zip | 78006-3303
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Country | US
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Telephone | 210-273-6173
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 772
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City | BOERNE
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State | TX
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Zip | 78006-0772
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Country | US
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Telephone | 210-273-6173
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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 | LPC 13072
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License Number State | TX
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