Healthcare Provider Details

I. General information

NPI: 1013769363
Provider Name (Legal Business Name): LIGHTSTREAM HEALTH L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20969 VENTURA BLVD STE 229
WOODLAND HILLS CA
91364-2378
US

IV. Provider business mailing address

20969 VENTURA BLVD STE 229
WOODLAND HILLS CA
91364-2378
US

V. Phone/Fax

Practice location:
  • Phone: 414-217-3847
  • Fax:
Mailing address:
  • Phone: 414-217-3847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LOREN LESHAN
Title or Position: OWNER
Credential:
Phone: 414-217-3847