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General NPI Number Information
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NPI Number | 1669084943
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Entity Type | Organization
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Legal Business Name | LUTHERAN SOCIAL SERVICES OF THE SOUTH, INC.
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Dates
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Enumeration Date | 08/19/2020
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Last Update Date | 08/19/2020
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Provider Practice Location Address
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Address Line | 10601 DERECHO DRIVE
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City | AUSTIN
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State | TX
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Zip | 78737-1013
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Country | US
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Telephone | 512-459-1000
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Fax | 512-706-7576
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Provider Business Mailing Address
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Address Line | 8305 CROSS PARK DRIVE
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City | AUSTIN
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State | TX
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Zip | 78754-5154
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Country | US
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Telephone | 512-459-1000
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Fax | 512-706-7576
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Authorized Official
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Title or Position | CHIEF PROGRAM OFFICER
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Name | MS. KRYSTALE BEZIO
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Credential | MSW, LCPAA
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Telephone | 512-459-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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