Provider Demographics
NPI:1245983824
Name:BEACON OF LIGHT BEHAVIORAL HEALTH, LLC.
Entity type:Organization
Organization Name:BEACON OF LIGHT BEHAVIORAL HEALTH, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:REGINA
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT, LPCC-S
Authorized Official - Phone:270-900-1358
Mailing Address - Street 1:300 W DIXIE AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-1764
Mailing Address - Country:US
Mailing Address - Phone:270-900-1358
Mailing Address - Fax:844-444-1150
Practice Address - Street 1:300 W DIXIE AVE STE 11
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-1764
Practice Address - Country:US
Practice Address - Phone:270-900-1358
Practice Address - Fax:844-444-1150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2022-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty