Provider Demographics
NPI:1891412797
Name:SOUTHERN LIGHT COUNSELING
Entity Type:Organization
Organization Name:SOUTHERN LIGHT COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-850-4555
Mailing Address - Street 1:610 E BATTLEFIELD ST # 113A
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-4806
Mailing Address - Country:US
Mailing Address - Phone:417-850-4555
Mailing Address - Fax:417-777-7017
Practice Address - Street 1:610 E BATTLEFIELD ST # 113A
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-4806
Practice Address - Country:US
Practice Address - Phone:417-850-4555
Practice Address - Fax:417-777-7017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-21
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty