Provider Demographics
NPI:1255504536
Name:MARCOS P HOLTZMAN
Entity Type:Organization
Organization Name:MARCOS P HOLTZMAN
Other - Org Name:LIGHTHOUSE COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARCOS
Authorized Official - Middle Name:P
Authorized Official - Last Name:HOLTZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC LCDC
Authorized Official - Phone:956-982-4511
Mailing Address - Street 1:1231 E LEVEE ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-5003
Mailing Address - Country:US
Mailing Address - Phone:956-982-4511
Mailing Address - Fax:956-544-7949
Practice Address - Street 1:1231 E LEVEE ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-5003
Practice Address - Country:US
Practice Address - Phone:956-982-4511
Practice Address - Fax:956-544-7949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19277101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1706690501Medicaid