Healthcare Provider Details

I. General information

NPI: 1033045620
Provider Name (Legal Business Name): LIGHT PATHWAY COUNSELING AND WELLNESS LICENSED INDEPENDENT SOCIAL WORKER CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8405 W 1ST ST
LOS ANGELES CA
90048-3412
US

IV. Provider business mailing address

8405 W 1ST ST
LOS ANGELES CA
90048-3412
US

V. Phone/Fax

Practice location:
  • Phone: 323-376-9857
  • Fax:
Mailing address:
  • Phone: 323-376-9857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: LENNY BRUCE HUGHLEY
Title or Position: PRESIDENT
Credential: LCSW
Phone: 323-376-9857