Provider Demographics
NPI:1306113659
Name:LIGHT HEART COUNSELING AND THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:LIGHT HEART COUNSELING AND THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:THIRY III
Authorized Official - Suffix:
Authorized Official - Credentials:LSW
Authorized Official - Phone:814-528-5323
Mailing Address - Street 1:4845 W LAKE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-2973
Mailing Address - Country:US
Mailing Address - Phone:814-528-5323
Mailing Address - Fax:814-725-0707
Practice Address - Street 1:4845 W LAKE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-2973
Practice Address - Country:US
Practice Address - Phone:814-528-5323
Practice Address - Fax:814-725-0707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW125058104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty