Provider Demographics
NPI:1669084943
Name:LUTHERAN SOCIAL SERVICES OF THE SOUTH, INC.
Entity type:Organization
Organization Name:LUTHERAN SOCIAL SERVICES OF THE SOUTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PROGRAM OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRYSTALE
Authorized Official - Middle Name:
Authorized Official - Last Name:BEZIO
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCPAA
Authorized Official - Phone:512-459-1000
Mailing Address - Street 1:8305 CROSS PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5154
Mailing Address - Country:US
Mailing Address - Phone:512-459-1000
Mailing Address - Fax:512-706-7576
Practice Address - Street 1:10601 DERECHO DRIVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78737-1013
Practice Address - Country:US
Practice Address - Phone:512-459-1000
Practice Address - Fax:512-706-7576
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUTHERAN SOCIAL SERVICES OF THE SOUTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty