Provider Demographics
NPI:1205135027
Name:LIGHTHEART INSTITUTE, LLC
Entity type:Organization
Organization Name:LIGHTHEART INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:TKACZ
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:860-254-5582
Mailing Address - Street 1:68 BRIDGE ST STE 203A
Mailing Address - Street 2:
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-2173
Mailing Address - Country:US
Mailing Address - Phone:860-254-5582
Mailing Address - Fax:860-254-5508
Practice Address - Street 1:68 BRIDGE ST STE 203A
Practice Address - Street 2:
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06078-2173
Practice Address - Country:US
Practice Address - Phone:860-254-5582
Practice Address - Fax:860-254-5508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-18
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty