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General NPI Number Information
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NPI Number | 1801482641
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Entity Type | Organization
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Legal Business Name | BEACON LIGHT MENTAL HEALTH LLC
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Dates
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Enumeration Date | 12/16/2020
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Last Update Date | 03/25/2023
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Provider Practice Location Address
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Address Line | 550 W HIGHWAY 105 STE 100
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City | MONUMENT
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State | CO
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Zip | 80132-9119
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Country | US
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Telephone | 719-373-5336
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Fax | 949-695-2184
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Provider Business Mailing Address
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Address Line | 545 3RD ST UNIT 3372
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City | MONUMENT
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State | CO
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Zip | 80132-4636
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Country | US
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Telephone | 303-956-0413
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Fax |
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Authorized Official
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Title or Position | NP
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Name | ROSS LEDGERWOOD
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Credential | PMHNP-BC
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Telephone | 303-956-0413
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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