Provider Demographics
NPI:1659998870
Name:MINDLIGHT LLC
Entity Type:Organization
Organization Name:MINDLIGHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APN, PMHNP-BC
Authorized Official - Phone:908-339-8696
Mailing Address - Street 1:114 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1806
Mailing Address - Country:US
Mailing Address - Phone:908-339-8696
Mailing Address - Fax:908-747-1228
Practice Address - Street 1:114 S 2ND ST
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1806
Practice Address - Country:US
Practice Address - Phone:610-704-6238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-03
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)