Provider Demographics
NPI:1194333450
Name:NEW LIGHT COACHING LLC
Entity type:Organization
Organization Name:NEW LIGHT COACHING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MACLAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-827-8116
Mailing Address - Street 1:PO BOX 963
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:AR
Mailing Address - Zip Code:72031-0963
Mailing Address - Country:US
Mailing Address - Phone:501-253-4691
Mailing Address - Fax:
Practice Address - Street 1:1467 MONTROSE RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:AR
Practice Address - Zip Code:72031-8653
Practice Address - Country:US
Practice Address - Phone:501-253-4691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-22
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Single Specialty