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General NPI Number Information
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NPI Number | 1467149856
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Entity Type | Organization
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Legal Business Name | LIGHT SPACE MENTAL HEALTH COUNSELING AND NURSE PRACTITIONER IN PSYCHIATRY PLLC
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Dates
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Enumeration Date | 04/18/2023
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Last Update Date | 08/15/2025
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Provider Practice Location Address
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Address Line | 418 BROADWAY STE 4279
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City | ALBANY
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State | NY
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Zip | 12207-2922
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Country | US
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Telephone | 937-756-6697
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Fax |
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Provider Business Mailing Address
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Address Line | 418 BROADWAY STE 4279
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City | ALBANY
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State | NY
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Zip | 12207-2922
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Country | US
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Telephone | 937-756-6697
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOEY BUKAI
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Credential | PMHNP-BC, LMHC, RN
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Telephone | 937-756-6697
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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