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General NPI Number Information
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NPI Number | 1508524539
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE COUNSELING OF SAN ANTONIO, PLLC
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Dates
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Enumeration Date | 12/07/2021
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | 6322 SOVEREIGN ST STE 242A
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City | SAN ANTONIO
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State | TX
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Zip | 78229-5134
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Country | US
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Telephone | 210-243-0951
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Fax |
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Provider Business Mailing Address
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Address Line | 6322 SOVEREIGN ST STE 242A
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City | SAN ANTONIO
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State | TX
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Zip | 78229-5134
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Country | US
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Telephone | 210-243-0951
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Fax |
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Authorized Official
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Title or Position | PROVIDER/OWNER
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Name | DIANA LUU
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Credential | LPC-S
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Telephone | 210-243-0951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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