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General NPI Number Information
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NPI Number | 1144875949
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Entity Type | Organization
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Legal Business Name | LIGHTED PATH RECOVERY CENTER
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Dates
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Enumeration Date | 08/08/2019
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Last Update Date | 04/07/2023
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Provider Practice Location Address
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Address Line | 4216 102ND ST STE 15
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City | LUBBOCK
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State | TX
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Zip | 79423-5707
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Country | US
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Telephone | 682-738-5482
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Fax |
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Provider Business Mailing Address
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Address Line | 4410 121ST LN
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City | LUBBOCK
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State | TX
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Zip | 79424-1386
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CYNTHIA JEFFERSON
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Credential | PHD, LMFT-S
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Telephone | 682-738-5482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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