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NPI Code Detail

MEDICARE: ADELLE LIGHT

MEDICARE: ADELLE LIGHT
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
1101YM0800XMental Health Counselor92047TX

General Provider Information

NPI Number : 1255293163
Entity Type Code : Individual
Provider Name (Legal Business Name) : ADELLE LIGHT
Provider Business Mailing Address
First Line : 2100 SCENIC DR STE 140
Second Line :
City : GEORGETOWN
State : TX
Zip : 78626-7720
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 107 FANNIN AVE
Second Line :
City : ROUND ROCK
State : TX
Zip : 78664-5218
Country : US
Telephone Number : 432-210-8018
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2025
Last Update Date : 04/09/2026

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Directions to “ ADELLE LIGHT ” Practice Location

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