Provider Demographics
NPI:1003583972
Name:SALT AND LIGHT PSYCHOLOGICAL SERVICES PLLC
Entity Type:Organization
Organization Name:SALT AND LIGHT PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGAR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:682-289-0546
Mailing Address - Street 1:1914 WOOD CREEK DR
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7056
Mailing Address - Country:US
Mailing Address - Phone:682-289-0546
Mailing Address - Fax:855-658-1426
Practice Address - Street 1:7165 COLLEYVILLE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-8009
Practice Address - Country:US
Practice Address - Phone:682-289-0546
Practice Address - Fax:855-658-1426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-26
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty