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NPI Code Detail

MEDICARE: ANITA LOUISE LIGHTFOOT LPC INTERN

MEDICARE: ANITA LOUISE LIGHTFOOT LPC INTERN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor76743TX

General Provider Information

NPI Number : 1003380460
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANITA LOUISE LIGHTFOOT LPC INTERN
Provider Business Mailing Address
First Line : 26229 N CRANES MILL RD
Second Line :
City : CANYON LAKE
State : TX
Zip : 78133-1957
Country : US
Telephone Number : 830-214-1559
Fax Number :
Provider Business Practice Location Address
First Line : 26229 N CRANES MILL RD
Second Line :
City : CANYON LAKE
State : TX
Zip : 78133-1957
Country : US
Telephone Number : 830-214-1559
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2019
Last Update Date : 01/17/2019

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Directions to “ ANITA LOUISE LIGHTFOOT LPC INTERN” Practice Location

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