Provider Demographics
NPI:1891165775
Name:BODDEN, LITZA CHRISTINA (LPC)
Entity Type:Individual
Prefix:MS
First Name:LITZA
Middle Name:CHRISTINA
Last Name:BODDEN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5075 PEAR RIDGE DR APT 615
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-3134
Mailing Address - Country:US
Mailing Address - Phone:972-670-4429
Mailing Address - Fax:
Practice Address - Street 1:5075 PEAR RIDGE DR APT 615
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75287-3134
Practice Address - Country:US
Practice Address - Phone:972-670-4429
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-05
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83-3362177Medicaid