Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 76743 | TX |
NPI | 1003380460 |
---|---|
Provider Name | Anita Louise Lightfoot |
First Address | Canyon Lake, TX 78133-1957 |
Second Address | Canyon Lake, TX 78133-1957 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2019 |
Last Update Date | 17/01/2019 |