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General NPI Number Information
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NPI Number | 1881319713
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Entity Type | Organization
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Legal Business Name | CHILDREN OF NUN'S LIGHTHOUSE TRUE BLUE CHRISTIAN COUNSELING CENTER
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 2012 SHADY BROOK DR
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City | BEDFORD
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State | TX
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Zip | 76021-5605
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Country | US
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Telephone | 817-754-0069
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 WIMBERLY CT
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City | BEDFORD
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State | TX
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Zip | 76021-2467
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Country | US
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Telephone | 817-754-0069
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. ANDREW NUNLEY III
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Credential | LPC
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Telephone | 817-754-0069
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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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Taxonomy #2
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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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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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