Healthcare Provider Details

I. General information

NPI: 1144058009
Provider Name (Legal Business Name): NEW LIGHT MENTAL HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2047 CRISMAN RD
PORTAGE IN
46368-1612
US

IV. Provider business mailing address

PO BOX 2257
CHESTERTON IN
46304-0357
US

V. Phone/Fax

Practice location:
  • Phone: 317-565-7328
  • Fax:
Mailing address:
  • Phone: 317-565-7328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: FRANCESCO ADAMO
Title or Position: OWNER
Credential: LMHC
Phone: 317-565-7328