Provider Demographics
NPI:1679269211
Name:WENDT, LILLIAN KAYE (LPC)
Entity Type:Individual
Prefix:MS
First Name:LILLIAN
Middle Name:KAYE
Last Name:WENDT
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 1:910 ELM GRV
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-5487
Mailing Address - Country:US
Mailing Address - Phone:972-824-4037
Mailing Address - Fax:
Practice Address - Street 1:1835 E SOUTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7067
Practice Address - Country:US
Practice Address - Phone:817-769-7687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86547101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health