Provider Demographics
NPI:1093922353
Name:EWAGATA, LILIAN SUSAN (LPC)
Entity Type:Individual
Prefix:
First Name:LILIAN
Middle Name:SUSAN
Last Name:EWAGATA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 SCRIPTURE ST
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-2324
Mailing Address - Country:US
Mailing Address - Phone:940-565-5289
Mailing Address - Fax:
Practice Address - Street 1:2519 SCRIPTURE ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2324
Practice Address - Country:US
Practice Address - Phone:940-565-5289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17078101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional