MEDICARE: LIGHT PATHWAY COUNSELING AND WELLNESS LICENSED INDEPENDENT SOCIAL WORKER CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1033045620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHT PATHWAY COUNSELING AND WELLNESS LICENSED INDEPENDENT SOCIAL WORKER CORPORATION

Provider Business Mailing Address
First Line	:	8405 W 1ST ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-3412
Country	:	US
Telephone Number	:	323-376-9857
Fax Number	:

Provider Business Practice Location Address
First Line	:	8405 W 1ST ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-3412
Country	:	US
Telephone Number	:	323-376-9857
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LENNY BRUCE HUGHLEY
Credential	:	LCSW
Telephone Number	:	323-376-9857

Provider Enumeration Date	:	06/22/2026
Last Update Date	:	06/22/2026

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