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General NPI Number Information
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NPI Number | 1003537341
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Entity Type | Organization
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Legal Business Name | LIGHT SIDE THERAPY LLC
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Dates
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Enumeration Date | 09/06/2022
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 1845 E RAND RD STE L109
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60004-4375
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Country | US
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Telephone | 773-490-8863
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Fax |
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Provider Business Mailing Address
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Address Line | 1845 E RAND RD STE L109
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60004-4375
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Country | US
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Telephone | 773-490-8863
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATIVE ASSISTANT
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Name | CAROL REGENHARDT
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Credential |
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Telephone | 773-490-8863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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