| Lighted Path Pllc | |
|
1124 Oak St Suite 250 Conway AR 72032-4318 | |
| (804) 592-1205 | |
| (866) 388-8128 |
| Full Name | Lighted Path Pllc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 1124 Oak St, Conway, Arkansas |
| Authorized Official Name and Position | Jeremy Lynn Dicicco (PRESIDENT) |
| Authorized Official Contact | 8045921205 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighted Path Pllc Po Box 224 Suite 250 Conway AR 72033-0224 Ph: (804) 592-1205 | Lighted Path Pllc 1124 Oak St Suite 250 Conway AR 72032-4318 Ph: (804) 592-1205 |
| NPI Number | 1134446958 |
|---|---|
| Provider Enumeration Date | 05/04/2010 |
| Last Update Date | 07/09/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134446958 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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