Provider Demographics
NPI:1801622980
Name:MAYBERRY, HILLARY A (LPC)
Entity type:Individual
Prefix:MRS
First Name:HILLARY
Middle Name:A
Last Name:MAYBERRY
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 W HOWARD DR
Mailing Address - Street 2:
Mailing Address - City:PUXICO
Mailing Address - State:MO
Mailing Address - Zip Code:63960-8407
Mailing Address - Country:US
Mailing Address - Phone:573-576-3747
Mailing Address - Fax:
Practice Address - Street 1:13147 STATE HIGHWAY AD
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-8472
Practice Address - Country:US
Practice Address - Phone:573-625-8587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025009340101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional