Provider Demographics
NPI:1639802911
Name:THE LIGHTED PATH COUNSELING LLC
Entity Type:Organization
Organization Name:THE LIGHTED PATH COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARENA
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:708-595-7101
Mailing Address - Street 1:7336 RANDOLPH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60130-1374
Mailing Address - Country:US
Mailing Address - Phone:708-860-0240
Mailing Address - Fax:
Practice Address - Street 1:917 W 18TH ST STE 210
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-2400
Practice Address - Country:US
Practice Address - Phone:708-595-7101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health