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General NPI Number Information
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NPI Number | 1700235603
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Entity Type | Organization
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Legal Business Name | LISA LOZANO DBA CREDENCE COUNSELING
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Dates
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Enumeration Date | 06/10/2016
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Last Update Date | 06/10/2016
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Provider Practice Location Address
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Address Line | 2114 W. MICHIGAN
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City | MIDLAND
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State | TX
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Zip | 79701
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Country | US
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Telephone | 432-634-6273
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Fax |
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Provider Business Mailing Address
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Address Line | 8730 W RIGGS DR UNIT A
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City | ODESSA
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State | TX
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Zip | 79764-8884
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Country | US
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Telephone | 432-634-6273
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Fax |
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Authorized Official
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Title or Position | OWNER/INDIVIDUAL
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Name | MRS. LISA MARIE LOZANO
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Credential | MA, LPC, NCC
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Telephone | 432-634-6273
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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 | 71305
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License Number State | TX
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