| Organization Name: | LAZARUS PROJECT GROUP PLLC |
| NPI Number: | 1306195151 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROLLA MERLE BRADLEY (COUNSELOR - OWNER) |
| Mailing Address: | 19185 Fm 2252 Garden Ridge |
| State: | TX US |
| Postal Code: | 782662574 |
| Phone Number: | 2108595446 |
| Fax Number: | |
| NPI Enumeration Date: | 09/06/2012 |
| NPI Last Update Date: | 09/06/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 14527 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |