Provider Demographics
NPI:1033613401
Name:LIGHTSEY EDUCATION
Entity Type:Organization
Organization Name:LIGHTSEY EDUCATION
Other - Org Name:LIGHTSEY EDUCATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:LIGHTSEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:469-230-0404
Mailing Address - Street 1:1836 BERWICK AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-4304
Mailing Address - Country:US
Mailing Address - Phone:469-203-0404
Mailing Address - Fax:469-466-6145
Practice Address - Street 1:2826 PROSPERITY AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75216-4721
Practice Address - Country:US
Practice Address - Phone:469-203-0404
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13277101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty