Provider Demographics
NPI:1225688708
Name:LEADING LIGHT BEHAVIORAL HEALTH, INC
Entity Type:Organization
Organization Name:LEADING LIGHT BEHAVIORAL HEALTH, INC
Other - Org Name:LLBH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:857-526-0487
Mailing Address - Street 1:500 WESTGATE DR # 1006
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-1855
Mailing Address - Country:US
Mailing Address - Phone:508-690-6069
Mailing Address - Fax:857-219-5242
Practice Address - Street 1:500 WESTGATE DR # 1006
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-1855
Practice Address - Country:US
Practice Address - Phone:508-690-6069
Practice Address - Fax:857-219-5242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-16
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty