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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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