MEDICARE: LIGHT OF LIFE COUNSELING SERVICES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	101YP2500X	Professional Counselor
2	1041C0700X	Clinical Social Worker
3	106H00000X	Marriage & Family Therapist
4	251S00000X	Community/Behavioral Health Agency	AZ

General Provider Information

NPI Number	:	1861931826
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHT OF LIFE COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	51 E MONROE AVE UNIT 1291
Second Line	:
City	:	BUCKEYE
State	:	AZ
Zip	:	85326-7551
Country	:	US
Telephone Number	:	623-628-8788
Fax Number	:	928-286-5158

Provider Business Practice Location Address
First Line	:	6500 S MILLER RD
Second Line	:
City	:	BUCKEYE
State	:	AZ
Zip	:	85326-1503
Country	:	US
Telephone Number	:	623-628-8788
Fax Number	:	928-286-5158

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	ULISES GONZALEZ
Credential	:	MAPC, LPC, LMFT
Telephone Number	:	623-628-8788

Provider Enumeration Date	:	02/22/2017
Last Update Date	:	08/20/2025

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