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General NPI Number Information
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NPI Number | 1780210294
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Entity Type | Organization
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Legal Business Name | LIGHT OF HOPE, LLC
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Dates
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Enumeration Date | 03/16/2020
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Last Update Date | 03/16/2020
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Provider Practice Location Address
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Address Line | 960 BROADWAY ST NE STE 3
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City | SALEM
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State | OR
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Zip | 97301-1275
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Country | US
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Telephone | 503-489-4747
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Fax | 503-489-9557
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Provider Business Mailing Address
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Address Line | 960 BROADWAY ST NE STE 3
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City | SALEM
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State | OR
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Zip | 97301-1275
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Country | US
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Telephone | 503-489-4747
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Fax | 503-489-9557
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Authorized Official
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Title or Position | OWNER/LICENSED CLINICAL SOCIAL WORK
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Name | LEAH MANGIS
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Credential | LCSW
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Telephone | 503-489-4747
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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