Provider Demographics
NPI:1659907889
Name:LIGHT ON LIFE COUNSELING & WELLNESS
Entity Type:Organization
Organization Name:LIGHT ON LIFE COUNSELING & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:I
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-227-9264
Mailing Address - Street 1:123 MESA VERDE ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1729
Mailing Address - Country:US
Mailing Address - Phone:860-227-9264
Mailing Address - Fax:
Practice Address - Street 1:1210 LUISA ST STE 5
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4175
Practice Address - Country:US
Practice Address - Phone:505-469-5577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health