Healthcare Provider Details

I. General information

NPI: 1669653143
Provider Name (Legal Business Name): FIRST LIGHT COUNSELING SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 BROWN ST
MEXICO ME
04257-1501
US

IV. Provider business mailing address

9 BROWN ST
MEXICO ME
04257-1501
US

V. Phone/Fax

Practice location:
  • Phone: 207-364-7006
  • Fax: 207-364-7007
Mailing address:
  • Phone: 207-364-7006
  • Fax: 207-364-7007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number450120
License Number StateME

VIII. Authorized Official

Name: MR. JIM MELLO
Title or Position: PRESIDENT
Credential: LADC/CCS
Phone: 207-364-7006