MEDICARE: LIGHT STRONG COUNSELING LLC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1902536147
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHT STRONG COUNSELING LLC

Provider Business Mailing Address
First Line	:	5426 N ACADEMY BLVD STE 103
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3686
Country	:	US
Telephone Number	:	719-920-0483
Fax Number	:

Provider Business Practice Location Address
First Line	:	5426 N ACADEMY BLVD STE 103
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3686
Country	:	US
Telephone Number	:	719-920-0483
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ERINN MARIE RYNEARSON
Credential	:	MA, LPC
Telephone Number	:	719-659-4130

Provider Enumeration Date	:	06/11/2022
Last Update Date	:	05/01/2023

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Directions to “LIGHT STRONG COUNSELING LLC ” Practice Location

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