Provider Demographics
NPI:1538597547
Name:LIGHT HEARTS COUNSELLING
Entity type:Organization
Organization Name:LIGHT HEARTS COUNSELLING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRIVATE THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:619-933-3771
Mailing Address - Street 1:5350 BALTIMORE DR
Mailing Address - Street 2:72
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-4612
Mailing Address - Country:US
Mailing Address - Phone:619-933-3771
Mailing Address - Fax:
Practice Address - Street 1:7484 UNIVERSITY AVE
Practice Address - Street 2:STE 210
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-6063
Practice Address - Country:US
Practice Address - Phone:619-933-3771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS26335251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health