Provider Demographics
NPI:1003215013
Name:MORNING LIGHT WELLNESS CENTERS, LLC
Entity Type:Organization
Organization Name:MORNING LIGHT WELLNESS CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICH
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC, QS
Authorized Official - Phone:727-425-7526
Mailing Address - Street 1:4601 34TH ST S
Mailing Address - Street 2:SUITE 126
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-4552
Mailing Address - Country:US
Mailing Address - Phone:727-425-7526
Mailing Address - Fax:
Practice Address - Street 1:4601 34TH ST S
Practice Address - Street 2:SUITE 126
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-4552
Practice Address - Country:US
Practice Address - Phone:727-425-7526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management