Provider Demographics
NPI:1174119523
Name:THE LIGHT PSYCHOTHERAPY AND COUNSELING SERVICE
Entity type:Organization
Organization Name:THE LIGHT PSYCHOTHERAPY AND COUNSELING SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CELINE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:KLECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, CADC
Authorized Official - Phone:810-610-2301
Mailing Address - Street 1:7274 LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-9397
Mailing Address - Country:US
Mailing Address - Phone:810-610-2301
Mailing Address - Fax:
Practice Address - Street 1:10315 GRAND RIVER RD STE 306
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-9586
Practice Address - Country:US
Practice Address - Phone:810-522-5208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)