Provider Demographics
NPI:1679365647
Name:LIGHTTRACE COUNSELING, LLC
Entity type:Organization
Organization Name:LIGHTTRACE COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:508-233-3474
Mailing Address - Street 1:50 MERIDIAN ST UNIT 456
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-7020
Mailing Address - Country:US
Mailing Address - Phone:508-233-3474
Mailing Address - Fax:
Practice Address - Street 1:50 MERIDIAN ST UNIT 456
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-7020
Practice Address - Country:US
Practice Address - Phone:508-233-3474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-19
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)