Provider Demographics
NPI:1508524539
Name:LIGHTHOUSE COUNSELING OF SAN ANTONIO, PLLC
Entity Type:Organization
Organization Name:LIGHTHOUSE COUNSELING OF SAN ANTONIO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUU
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:210-243-0951
Mailing Address - Street 1:6322 SOVEREIGN ST STE 242A
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5134
Mailing Address - Country:US
Mailing Address - Phone:210-243-0951
Mailing Address - Fax:
Practice Address - Street 1:6322 SOVEREIGN ST STE 242A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5134
Practice Address - Country:US
Practice Address - Phone:210-243-0951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health