Provider Demographics
NPI:1578279998
Name:LEADLIGHT LLC
Entity Type:Organization
Organization Name:LEADLIGHT LLC
Other - Org Name:LEADLIGHT COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:NB
Authorized Official - Last Name:BLODGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-651-2084
Mailing Address - Street 1:217 E 24TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4973
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8326 S DIVISION AVE
Practice Address - Street 2:
Practice Address - City:BYRON CENTER
Practice Address - State:MI
Practice Address - Zip Code:49315-9031
Practice Address - Country:US
Practice Address - Phone:847-651-2084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-30
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty