Organization
ON EPIPHANY LANE, LLC
Active
Organization
ON EPIPHANY LANE, LLC
Active
Other names
Epiphany Lane Counseling
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY NEULENE LINDLEY LPC-S (MANAGING MEMBER)
(214) 560-0304
Entity
Organization
Contact information
Practice address
603 MUNGER AVE STE 100, DALLAS, TX 75202-1840
(214) 560-0304
Mailing address
603 MUNGER AVE # 100-239, DALLAS, TX 75202-1839
(214) 560-0304
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
251K00000X
Public Health or Welfare Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1215272737
NPI
TX
Enumeration date
11/02/2020
Last updated
11/02/2020
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