Provider Demographics
NPI:1881067635
Name:LIGHTED PATHWAYS COUNSELING SERVICE
Entity type:Organization
Organization Name:LIGHTED PATHWAYS COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/ MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:SHUNTA
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:601-982-0948
Mailing Address - Street 1:2080 DUNBARTON DR STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-5016
Mailing Address - Country:US
Mailing Address - Phone:601-982-0948
Mailing Address - Fax:
Practice Address - Street 1:2080 DUNBARTON DR STE 1
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-5016
Practice Address - Country:US
Practice Address - Phone:601-982-0948
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1210101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty