Provider Demographics
NPI:1326614678
Name:LIGHT OF THE PINES, LLC
Entity Type:Organization
Organization Name:LIGHT OF THE PINES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:936-875-4555
Mailing Address - Street 1:PO BOX 154735
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75915-4735
Mailing Address - Country:US
Mailing Address - Phone:936-875-4555
Mailing Address - Fax:936-236-4715
Practice Address - Street 1:1705A FEAGIN DR # 164
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-5535
Practice Address - Country:US
Practice Address - Phone:936-875-4555
Practice Address - Fax:936-236-4715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-27
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health