Healthcare Provider Details

I. General information

NPI: 1184545956
Provider Name (Legal Business Name): LIGHT WITHIN THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 N JEFFERSON ST
OTTUMWA IA
52501-2018
US

IV. Provider business mailing address

PO BOX 135
OTTUMWA IA
52501-0135
US

V. Phone/Fax

Practice location:
  • Phone: 641-208-0012
  • Fax:
Mailing address:
  • Phone: 641-208-0012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: MIKAELA HOFFMAN
Title or Position: LMHC
Credential:
Phone: 641-208-0012