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General NPI Number Information
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NPI Number | 1659907889
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Entity Type | Organization
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Legal Business Name | LIGHT ON LIFE COUNSELING & WELLNESS
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Dates
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Enumeration Date | 03/19/2020
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Last Update Date | 03/19/2020
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Provider Practice Location Address
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Address Line | 1210 LUISA ST STE 5
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City | SANTA FE
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State | NM
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Zip | 87505-4175
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Country | US
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Telephone | 505-469-5577
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Fax |
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Provider Business Mailing Address
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Address Line | 123 MESA VERDE ST
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City | SANTA FE
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State | NM
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Zip | 87501-1729
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Country | US
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Telephone | 860-227-9264
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ELLEN I PATTERSON
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Credential |
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Telephone | 860-227-9264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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