=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770471385
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOLISTIC LIGHT SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2025
-----------------------------------------------------
Last Update Date | 06/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4539 N 22ND ST STE N
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85016-4639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-888-3723
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4539 N 22ND ST STE N
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85016-4639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 602-888-3723
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICIAN/OWNER
-----------------------------------------------------
Name | BRITTANY CACHO
-----------------------------------------------------
Credential | LPC
-----------------------------------------------------
Telephone | 602-888-3723
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------