Provider Demographics
NPI:1013331115
Name:LIFETIME CHRISTIAN COUNSELORS LLC
Entity Type:Organization
Organization Name:LIFETIME CHRISTIAN COUNSELORS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:PFEIFER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:210-818-1707
Mailing Address - Street 1:13302 POSSUM CIR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-4764
Mailing Address - Country:US
Mailing Address - Phone:210-818-1707
Mailing Address - Fax:210-641-2940
Practice Address - Street 1:3740 COLONY DR STE 125
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2365
Practice Address - Country:US
Practice Address - Phone:210-501-9377
Practice Address - Fax:210-641-2940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10351101Y00000X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX213205204Medicaid