Healthcare Provider Details

I. General information

NPI: 1093630261
Provider Name (Legal Business Name): BOUNDLESS LIGHT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14435 S 48TH ST APT 2174
PHOENIX AZ
85044-6443
US

IV. Provider business mailing address

14435 S 48TH ST APT 2174
PHOENIX AZ
85044-6443
US

V. Phone/Fax

Practice location:
  • Phone: 626-537-9702
  • Fax:
Mailing address:
  • Phone: 626-537-9702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: CHIENYU LIN
Title or Position: MANAGER
Credential: LMFT
Phone: 626-537-9702