Provider Demographics
NPI:1790389559
Name:YABUT, LILIAN IONA (LCPC ATR)
Entity Type:Individual
Prefix:
First Name:LILIAN IONA
Middle Name:
Last Name:YABUT
Suffix:
Gender:F
Credentials:LCPC ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13426 WATERS EDGE WAY
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-6067
Mailing Address - Country:US
Mailing Address - Phone:406-223-1636
Mailing Address - Fax:
Practice Address - Street 1:13426 WATERS EDGE WAY
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-6067
Practice Address - Country:US
Practice Address - Phone:406-223-1636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT45187101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health