Provider Demographics
NPI:1699284406
Name:LOVE YOUR LIGHT LLC
Entity type:Organization
Organization Name:LOVE YOUR LIGHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:R
Authorized Official - Last Name:MOYA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:505-920-2258
Mailing Address - Street 1:2074 GALISTEO ST STE B4
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2157
Mailing Address - Country:US
Mailing Address - Phone:505-920-2258
Mailing Address - Fax:505-303-3500
Practice Address - Street 1:2074 GALISTEO ST STE B4
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2157
Practice Address - Country:US
Practice Address - Phone:505-920-2258
Practice Address - Fax:505-303-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-25
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC093701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty