Provider Demographics
NPI:1992931844
Name:VINE DWELLERS MINISTRIES INC
Entity type:Organization
Organization Name:VINE DWELLERS MINISTRIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/COUNSELOR/THERAPIST/CASEMNGR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:LIGHTFOOT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LPC, LCSW
Authorized Official - Phone:713-287-1492
Mailing Address - Street 1:12319 CHESTERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77031-3107
Mailing Address - Country:US
Mailing Address - Phone:713-287-1492
Mailing Address - Fax:281-879-4758
Practice Address - Street 1:12319 CHESTERBROOK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77031-3107
Practice Address - Country:US
Practice Address - Phone:713-287-1492
Practice Address - Fax:281-879-4758
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VINE DWELLERS MINISTRIES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-05
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13993251B00000X, 251V00000X
TX6759251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health