| Light Source Llc | |
|
114 E Lincoln St Belleville IL 62220-2251 | |
| (618) 444-9934 | |
| Not Available |
| Full Name | Light Source Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 114 E Lincoln St, Belleville, Illinois |
| Authorized Official Name and Position | Charles Franke (LCSW/OWNER) |
| Authorized Official Contact | 6184449934 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Light Source Llc 114 E Lincoln St Belleville IL 62220-2251 Ph: (618) 444-9934 | Light Source Llc 114 E Lincoln St Belleville IL 62220-2251 Ph: (618) 444-9934 |
| NPI Number | 1902454689 |
|---|---|
| Provider Enumeration Date | 08/27/2019 |
| Last Update Date | 08/27/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902454689 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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