Provider Demographics
NPI:1033359435
Name:LILES COUNSELING PROFESSIONAL LIMITED LIABILITY COMPANY
Entity Type:Organization
Organization Name:LILES COUNSELING PROFESSIONAL LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:AYDEN
Authorized Official - Last Name:LILES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:254-624-6755
Mailing Address - Street 1:10486 BURGESS RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76501-7371
Mailing Address - Country:US
Mailing Address - Phone:254-624-6755
Mailing Address - Fax:
Practice Address - Street 1:1000 W STATE HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712-3786
Practice Address - Country:US
Practice Address - Phone:254-776-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63247251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health