1114164001 NPI number — LIGHTEN YOUR LOAD, LLC

Table of content: (NPI 1114164001)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114164001 NPI number — LIGHTEN YOUR LOAD, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIGHTEN YOUR LOAD, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114164001
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 E WARNER RD
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85284-3224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-268-9830
Provider Business Mailing Address Fax Number:
480-753-5421

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 E WARNER RD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85284-3224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-268-9830
Provider Business Practice Location Address Fax Number:
480-753-5421
Provider Enumeration Date:
01/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
EUGENE
Authorized Official Title or Position:
PSYCHOLOGIST/MANAGER
Authorized Official Telephone Number:
480-268-9830

Provider Taxonomy Codes

  • Taxonomy code: 103TC1900X , with the licence number:  3462 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com