Provider Demographics
NPI:1154780997
Name:BLUE LIGHT COUNSELING
Entity type:Organization
Organization Name:BLUE LIGHT COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAGON
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:603-724-0079
Mailing Address - Street 1:180 EAGLE OWL LOOP
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-2712
Mailing Address - Country:US
Mailing Address - Phone:603-724-0079
Mailing Address - Fax:
Practice Address - Street 1:3008 DAWN DR
Practice Address - Street 2:SUITE 101
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2821
Practice Address - Country:US
Practice Address - Phone:603-724-0079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73209101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty