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7815 Hertfordshire Dr Spring TX 77379-4652 | |
| (281) 570-4523 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 7815 Hertfordshire Dr, Spring, Texas |
| Authorized Official Name and Position | Kyntra Lighten (OWNER) |
| Authorized Official Contact | 2815704523 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
7815 Hertfordshire Dr Spring TX 77379-4652 Ph: (281) 570-4523 | 7815 Hertfordshire Dr Spring TX 77379-4652 Ph: (281) 570-4523 |
| NPI Number | 1568854446 |
|---|---|
| Provider Enumeration Date | 03/02/2015 |
| Last Update Date | 07/25/2024 |
| Certification Date | 07/25/2024 |
| Medicare PECOS PAC ID | 5193265155 |
|---|---|
| Medicare Enrollment ID | O20240905002936 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568854446 | NPI | - | NPPES |
| 171494105 | Medicaid | TX | |
| 171494103 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 19226 (Texas) | Primary |
| Provider Name | Kyntra Chandler Lighten |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1174629281 PECOS PAC ID: 6002356060 Enrollment ID: I20240905003088 |
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