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General NPI Number Information
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NPI Number | 1467855312
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Entity Type | Organization
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Legal Business Name | JUSSI LIGHT THERAPY & COUNSELING
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Dates
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Enumeration Date | 10/07/2014
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Last Update Date | 10/07/2014
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Provider Practice Location Address
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Address Line | 2850 PIO PICO DR SUITE K
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City | CARLSBAD
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State | CA
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Zip | 92008-1554
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Country | US
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Telephone | 760-494-4394
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Fax | 760-494-4394
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Provider Business Mailing Address
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Address Line | PO BOX 2700
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City | CARLSBAD
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State | CA
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Zip | 92018-2700
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Country | US
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Telephone | 760-494-4394
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Fax | 760-494-4394
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Authorized Official
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Title or Position | OWNER
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Name | JUSSI M LIGHT
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Credential | LMFT
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Telephone | 760-494-4394
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 39617
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License Number State | CA
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