Provider Demographics
NPI:1528418415
Name:WILBOURN, LINDA SUSAN (LPC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:SUSAN
Last Name:WILBOURN
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 1:121 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-7070
Mailing Address - Country:US
Mailing Address - Phone:512-797-1261
Mailing Address - Fax:
Practice Address - Street 1:1127 MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-3580
Practice Address - Country:US
Practice Address - Phone:830-257-3009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-21
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67171101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional