Provider Demographics
NPI:1699073098
Name:LIGHTHOUSE WOMEN MINISTRIES ASSOCIATIONOF AMERICA INCORPORATED
Entity type:Organization
Organization Name:LIGHTHOUSE WOMEN MINISTRIES ASSOCIATIONOF AMERICA INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR OF PROGRAM DEVLO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JATIS
Authorized Official - Middle Name:JE JUAN
Authorized Official - Last Name:MCCOLLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-291-9826
Mailing Address - Street 1:1406 HORTON DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-1328
Mailing Address - Country:US
Mailing Address - Phone:972-291-9826
Mailing Address - Fax:
Practice Address - Street 1:1406 HORTON DR
Practice Address - Street 2:
Practice Address - City:CEDAR HILL
Practice Address - State:TX
Practice Address - Zip Code:75104-1328
Practice Address - Country:US
Practice Address - Phone:972-291-9826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty