Provider Demographics
NPI:1306527577
Name:THE LIGHTED PATH LLC
Entity type:Organization
Organization Name:THE LIGHTED PATH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MANDI
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:ABERNATHY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPCC
Authorized Official - Phone:505-508-7071
Mailing Address - Street 1:215 COWBOY WAY STE 106
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:NM
Mailing Address - Zip Code:87015-9616
Mailing Address - Country:US
Mailing Address - Phone:505-508-7071
Mailing Address - Fax:505-508-0771
Practice Address - Street 1:215 COWBOY WAY STE 106
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:NM
Practice Address - Zip Code:87015-9616
Practice Address - Country:US
Practice Address - Phone:505-508-7071
Practice Address - Fax:505-508-0771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-28
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMN0029903Medicaid