MEDICARE: LIVE LIGHT COUNSELING, PLLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1790530285
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIVE LIGHT COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	2501 N HAYDEN RD STE 103
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85257-2326
Country	:	US
Telephone Number	:	480-331-7701
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 N HAYDEN RD STE 103
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85257-2326
Country	:	US
Telephone Number	:	480-331-7701
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	MRS. TERESA NELSON
Credential	:	LPC
Telephone Number	:	480-331-7701

Provider Enumeration Date	:	04/18/2024
Last Update Date	:	04/18/2024

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