=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508624743
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LT COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2024
-----------------------------------------------------
Last Update Date | 03/12/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4125 FAIRWAY DR STE 130
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75010-4161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-885-1222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4125 FAIRWAY DR STE 130
-----------------------------------------------------
City | CARROLLTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75010-4161
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-885-1222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER - ASSISTANT CLINICAL DIRECTOR
-----------------------------------------------------
Name | SHERNAZ NASTA
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 972-885-1222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------