=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841099090
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTH LIGHT BEHAVIORAL SERVICES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/11/2025
-----------------------------------------------------
Last Update Date | 03/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2909 E ARKANSAS LN STE C
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76010-6930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-259-0637
-----------------------------------------------------
Fax | 682-259-0637
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2909 E ARKANSAS LN STE C
-----------------------------------------------------
City | ARLINGTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76010-6930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 682-259-0637
-----------------------------------------------------
Fax | 682-259-0637
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ENOCH ADOMAKO
-----------------------------------------------------
Credential | OWNER
-----------------------------------------------------
Telephone | 719-941-1400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------