Provider Demographics
NPI:1427876028
Name:LOVE & LIGHT COUNSELING, LLC
Entity type:Organization
Organization Name:LOVE & LIGHT COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:ANN LOUISE
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:612-208-8085
Mailing Address - Street 1:4050 147TH LN NW
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MN
Mailing Address - Zip Code:55304-3124
Mailing Address - Country:US
Mailing Address - Phone:612-208-8085
Mailing Address - Fax:
Practice Address - Street 1:690 HUMBOLDT DR STE I&K
Practice Address - Street 2:
Practice Address - City:BIG LAKE
Practice Address - State:MN
Practice Address - Zip Code:55309-4812
Practice Address - Country:US
Practice Address - Phone:612-208-8085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-01
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty