Provider Demographics
NPI:1396100657
Name:TRAVELING LIGHT COUNSELING INC
Entity type:Organization
Organization Name:TRAVELING LIGHT COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:772-361-8448
Mailing Address - Street 1:1222 SE PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5364
Mailing Address - Country:US
Mailing Address - Phone:772-361-8448
Mailing Address - Fax:844-269-6480
Practice Address - Street 1:1222 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5364
Practice Address - Country:US
Practice Address - Phone:772-361-8448
Practice Address - Fax:844-269-6480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW12224261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013286400Medicaid
FLIB295YMedicare Oscar/Certification