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General NPI Number Information
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NPI Number | 1306113659
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Entity Type | Organization
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Legal Business Name | LIGHT HEART COUNSELING AND THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 11/30/2011
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Provider Practice Location Address
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Address Line | 4845 W LAKE RD SUITE 120
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City | ERIE
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State | PA
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Zip | 16505-2973
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Country | US
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Telephone | 814-528-5323
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Fax | 814-725-0707
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Provider Business Mailing Address
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Address Line | 4845 W LAKE RD SUITE 120
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City | ERIE
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State | PA
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Zip | 16505-2973
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Country | US
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Telephone | 814-528-5323
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Fax | 814-725-0707
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Authorized Official
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Title or Position | OWNER
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Name | EDWARD THIRY III
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Credential | LSW
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Telephone | 814-528-5323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW125058
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License Number State | PA
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