Provider Demographics
NPI:1013773399
Name:ETERNAL LIGHT CHRISTIAN COUNSELING SERVICES
Entity Type:Organization
Organization Name:ETERNAL LIGHT CHRISTIAN COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR / COO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:210-846-5269
Mailing Address - Street 1:809 SWIFT FOX
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-4083
Mailing Address - Country:US
Mailing Address - Phone:210-846-5269
Mailing Address - Fax:
Practice Address - Street 1:809 SWIFT FOX
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-4083
Practice Address - Country:US
Practice Address - Phone:210-846-5269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Single Specialty