Provider Demographics
NPI:1003537341
Name:LIGHT SIDE THERAPY LLC
Entity Type:Organization
Organization Name:LIGHT SIDE THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:REGENHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-490-8863
Mailing Address - Street 1:1845 E RAND RD STE L109
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4375
Mailing Address - Country:US
Mailing Address - Phone:773-490-8863
Mailing Address - Fax:
Practice Address - Street 1:1845 E RAND RD STE L109
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4375
Practice Address - Country:US
Practice Address - Phone:773-490-8863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty