Provider Demographics
NPI:1396938262
Name:NEW LIGHT CONSULTANTS
Entity type:Organization
Organization Name:NEW LIGHT CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:O
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MSW LMSW
Authorized Official - Phone:989-871-6695
Mailing Address - Street 1:PO BOX 359
Mailing Address - Street 2:8511 STATE ST.
Mailing Address - City:MILLINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:48746-0359
Mailing Address - Country:US
Mailing Address - Phone:989-871-6695
Mailing Address - Fax:989-871-3663
Practice Address - Street 1:8511 STATE RD
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:MI
Practice Address - Zip Code:48746-9446
Practice Address - Country:US
Practice Address - Phone:989-871-6695
Practice Address - Fax:989-871-3663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI790026261QR0405X, 251S00000X, 261QM0855X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use DisorderGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP11240Medicare PIN