Provider Demographics
NPI:1265153969
Name:WAY OF LIGHT LOVE
Entity type:Organization
Organization Name:WAY OF LIGHT LOVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TASHEDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEONARD-HAYSELDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PSYD
Authorized Official - Phone:619-738-4017
Mailing Address - Street 1:14740 BASS DR SPC 8
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-8403
Mailing Address - Country:US
Mailing Address - Phone:619-738-4017
Mailing Address - Fax:
Practice Address - Street 1:14740 BASS DR SPC 8
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-8403
Practice Address - Country:US
Practice Address - Phone:619-738-4017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-09
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No177F00000XOther Service ProvidersLodgingGroup - Multi-Specialty
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical ExaminerGroup - Multi-Specialty
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Multi-Specialty
No251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No174200000XOther Service ProvidersMealsGroup - Multi-Specialty
No175T00000XOther Service ProvidersPeer SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0091733OtherWOLLCARE COMMUNITY HEALTH NETWORK