Healthcare Provider Details

I. General information

NPI: 1568182673
Provider Name (Legal Business Name): NEW LIGHT COUSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2022
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 WILLOWBROOK DR
SALTILLO MS
38866-6896
US

IV. Provider business mailing address

131 WILLOWBROOK DR
SALTILLO MS
38866-6896
US

V. Phone/Fax

Practice location:
  • Phone: 662-401-6547
  • Fax: 662-346-5438
Mailing address:
  • Phone: 662-401-6547
  • Fax: 662-346-5438

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: MARK RUSSELL
Title or Position: OWNER
Credential: LCSW
Phone: 662-401-6457