1700235603 NPI number — LISA LOZANO DBA CREDENCE COUNSELING

Table of content: (NPI 1700235603)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700235603 NPI number — LISA LOZANO DBA CREDENCE COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LISA LOZANO DBA CREDENCE COUNSELING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700235603
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8730 W RIGGS DR UNIT A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ODESSA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79764-8884
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-634-6273
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2114 W. MICHIGAN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-634-6273
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2016

Additional Information

Authorized Official

Authorized Official Last Name:
LOZANO
Authorized Official First Name:
LISA
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
OWNER/INDIVIDUAL
Authorized Official Telephone Number:
432-634-6273

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  71305 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1790083491 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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