=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396100657
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRAVELING LIGHT COUNSELING INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/30/2015
-----------------------------------------------------
Last Update Date | 11/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1222 SE PORT ST LUCIE BLVD
-----------------------------------------------------
City | PORT SAINT LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34952-5364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-361-8448
-----------------------------------------------------
Fax | 844-269-6480
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1222 SE PORT ST LUCIE BLVD
-----------------------------------------------------
City | PORT SAINT LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34952-5364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-361-8448
-----------------------------------------------------
Fax | 844-269-6480
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LCSW/PRESIDENT
-----------------------------------------------------
Name | MRS. YVETTE MCDONALD
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 772-361-8448
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | SW12224
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------