Healthcare Provider Details

I. General information

NPI: 1538203484
Provider Name (Legal Business Name): LUTHERAN SOCIAL SERVICES OF THE SOUTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 07/26/2021
Certification Date: 07/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 SCARBOUROUGH
CANYON LAKE TX
78133-4529
US

IV. Provider business mailing address

8305 CROSS PARK DR
AUSTIN TX
78754-5154
US

V. Phone/Fax

Practice location:
  • Phone: 830-964-4390
  • Fax: 830-964-4391
Mailing address:
  • Phone: 512-459-1000
  • Fax: 512-452-6885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: MS. KRYSTALE BEZIO
Title or Position: CHIEF PROGRAM OFFICER
Credential: MSW, LCPAA
Phone: 512-459-1000