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General NPI Number Information
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NPI Number | 1033613401
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Entity Type | Organization
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Legal Business Name | LIGHTSEY EDUCATION
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Dates
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Enumeration Date | 03/21/2018
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Last Update Date | 03/21/2018
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Provider Practice Location Address
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Address Line | 2826 PROSPERITY AVE
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City | DALLAS
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State | TX
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Zip | 75216-4721
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Country | US
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Telephone | 469-203-0404
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Fax |
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Provider Business Mailing Address
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Address Line | 1836 BERWICK AVE
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City | DALLAS
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State | TX
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Zip | 75203-4304
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Country | US
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Telephone | 469-203-0404
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Fax | 469-466-6145
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Authorized Official
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Title or Position | COUNSELOR
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Name | KATHY RENEE LIGHTSEY
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Credential | LCDC
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Telephone | 469-230-0404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 13277
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License Number State | TX
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