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General NPI Number Information
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NPI Number | 1699073098
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE WOMEN MINISTRIES ASSOCIATIONOF AMERICA INCORPORATED
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Dates
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Enumeration Date | 03/09/2011
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Last Update Date | 03/09/2011
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Provider Practice Location Address
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Address Line | 1406 HORTON DR
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City | CEDAR HILL
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State | TX
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Zip | 75104-1328
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Country | US
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Telephone | 972-291-9826
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Fax |
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Provider Business Mailing Address
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Address Line | 1406 HORTON DR
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City | CEDAR HILL
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State | TX
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Zip | 75104-1328
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Country | US
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Telephone | 972-291-9826
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/DIRECTOR OF PROGRAM DEVLO
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Name | MRS. JATIS JE JUAN MCCOLLISTER
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Credential |
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Telephone | 972-291-9826
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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