Maxine Wilborn, LPC, PHD

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

96928 Issued in TX

Practice address

1603 Babcock Rd Ste 238-5
San Antonio, TX 78229-4708

Phone

(830) 570-1967

NPI assigned

Mar 14, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Synergistic Body and Mind

  • Mental Health Counselor
  • San Antonio, TX
  • NPI 1598587263

  Mental Health

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1331683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756944000000",
    "number": "1861767477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 HICKORY RUN",
            "city": "LA VERNIA",
            "state": "TX",
            "postal_code": "781215852",
            "telephone_number": "830-570-1967"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1603 BABCOCK RD STE 238-5",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782294708",
            "telephone_number": "830-570-1967"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILBORN",
        "first_name": "MAXINE",
        "credential": "LPC, PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-03-14",
        "last_updated": "2025-09-04",
        "certification_date": "2025-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "96928",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "TX",
            "license": "96928",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marka Rasan Wight, LPC
• Amadea Jocelyn Wijayanto, DDS
• Wilbea Medical Equipment LLC
• Judith J Wilber, MD
• Ronald Thomas Wilber, P.A.
• Kristina Wilbraham
• Wilbur S. Avant, Jr.,M.D.,P.a.
• Melissa Wilbur-Carrera
• Matthew Wilbur
• Amanda Lauren Wilburn

• All providers in San Antonio, TX
• Professional Counselor in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.