Provider Demographics
NPI:1356096077
Name:OWL LIGHT COUNSELING LLC
Entity Type:Organization
Organization Name:OWL LIGHT COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:775-910-1736
Mailing Address - Street 1:1050 E ELDERBERRY ST
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-7149
Mailing Address - Country:US
Mailing Address - Phone:775-910-1736
Mailing Address - Fax:
Practice Address - Street 1:1050 E ELDERBERRY ST
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-7149
Practice Address - Country:US
Practice Address - Phone:775-910-1736
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health