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Individual

MRS. LILLIE MARIE JANUARY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LPC

Contact information

Practice address
3720 DURWOOD DR, BEAUMONT, TX 77706-3708
(409) 330-1181
Mailing address
3720 DURWOOD DR, BEAUMONT, TX 77706-3708
(409) 330-1181

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
14023
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
121955201
TX
01
240401
VALUE OPTIONS
TX
01
3638LC
BLUE CROSS BLUE SHIELD
TX
Enumeration date
07/07/2006
Last updated
08/11/2008
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