=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174629281
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KYNTRA CHANDLER LIGHTEN MED
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/15/2006
-----------------------------------------------------
Last Update Date | 05/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7815 HERTFORDSHIRE DR
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77379-4652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-570-4523
-----------------------------------------------------
Fax | 281-570-4524
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7815 HERTFORDSHIRE DR
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77379-4652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-570-4523
-----------------------------------------------------
Fax | 281-570-4524
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 19226
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------