Individual
LILLIAM POLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1626 W HWY 287 BUS STE 101, WAXAHACHIE, TX 75165-4728
(214) 864-6988
(972) 906-9112
Mailing address
1626 W HWY 287 BUS STE 101, WAXAHACHIE, TX 75165-4728
(214) 864-6988
(972) 906-9112
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
12045
TX
101YM0800X
Mental Health Counselor
12045
TX
174400000X
Specialist
12045
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013287721
—
TX
Enumeration date
02/03/2016
Last updated
04/15/2020
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