Provider Demographics
NPI:1255637112
Name:WILLIAMS, LYLBURN CLINTON
Entity type:Individual
Prefix:MR
First Name:LYLBURN
Middle Name:CLINTON
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:CLINT
Other - Middle Name:
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:702 SAN PEDRO AVE
Mailing Address - Street 2:NONE
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4610
Mailing Address - Country:US
Mailing Address - Phone:210-299-2400
Mailing Address - Fax:210-299-2413
Practice Address - Street 1:702 SAN PEDRO AVE
Practice Address - Street 2:NONE
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4610
Practice Address - Country:US
Practice Address - Phone:210-563-4938
Practice Address - Fax:210-299-2413
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63759101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor