| Lighted Path Therapy Services | |
|
901 N. Leatherleaf Loop Suite 103 Wasilla AK 99654 | |
| (907) 312-1202 | |
| (855) 553-8083 |
| Full Name | Lighted Path Therapy Services |
|---|---|
| Speciality | Counselor - Professional |
| Location | 901 N. Leatherleaf Loop Suite 103, Wasilla, Alaska |
| Authorized Official Name and Position | Bradford Eric Holl (OWNER) |
| Authorized Official Contact | 9073121202 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighted Path Therapy Services Po Box 871336 Wasilla AK 99654 Ph: (907) 312-1202 | Lighted Path Therapy Services 901 N. Leatherleaf Loop Suite 103 Wasilla AK 99654 Ph: (907) 312-1202 |
| NPI Number | 1093212466 |
|---|---|
| Provider Enumeration Date | 04/11/2018 |
| Last Update Date | 04/11/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093212466 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 809 (Alaska) | Primary |
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