Provider Demographics
NPI:1720333107
Name:LOVING LIGHT PSYCHOTHERAPY CENTER, LLC
Entity Type:Organization
Organization Name:LOVING LIGHT PSYCHOTHERAPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHULTHEISS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-495-4604
Mailing Address - Street 1:1762 HOFFMAN DR
Mailing Address - Street 2:SUITE H-2
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4292
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1762 HOFFMAN DR
Practice Address - Street 2:SUITE H-2
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4292
Practice Address - Country:US
Practice Address - Phone:970-495-4604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty