MEDICARE: LIGHT HEARTS COUNSELLING

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	251S00000X	Community/Behavioral Health Agency	LCS26335	CA

General Provider Information

NPI Number	:	1538597547
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHT HEARTS COUNSELLING

Provider Business Mailing Address
First Line	:	5350 BALTIMORE DR
Second Line	:	72
City	:	LA MESA
State	:	CA
Zip	:	91942-4612
Country	:	US
Telephone Number	:	619-933-3771
Fax Number	:

Provider Business Practice Location Address
First Line	:	7484 UNIVERSITY AVE
Second Line	:	STE 210
City	:	LA MESA
State	:	CA
Zip	:	91942-6063
Country	:	US
Telephone Number	:	619-933-3771
Fax Number	:

Authorized Official
Title or Position	:	PRIVATE THERAPIST
Name	:	MS. JUDY A JOHNSON
Credential	:	LCSW
Telephone Number	:	619-933-3771

Provider Enumeration Date	:	10/30/2013
Last Update Date	:	10/30/2013

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Directions to “LIGHT HEARTS COUNSELLING ” Practice Location

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