Provider Demographics
NPI:1417493503
Name:MABRY, LILIAN R (LPC)
Entity Type:Individual
Prefix:
First Name:LILIAN
Middle Name:R
Last Name:MABRY
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 1:3402 BOWDEN HILL LN N
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-4963
Mailing Address - Country:US
Mailing Address - Phone:817-266-0865
Mailing Address - Fax:
Practice Address - Street 1:3402 BOWDEN HILL LN N
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-4963
Practice Address - Country:US
Practice Address - Phone:817-266-0865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-12
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX08933101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional