Shadow and Light Wellness LLC

NPI #1023823531 in Ammon, Idaho

Provider Information

NPI Number: 1023823531
Entity Type: Organization
Organization Name: Shadow and Light Wellness LLC
Primary Specialty: Counselor - Mental Health
Enumeration Date: Feb 11, 2025
Last Updated: Feb 11, 2025

Practice Location

Address: 919 S 25TH E
City: Ammon
State: Idaho
ZIP Code: 83406-5731
Phone: (208) 227-3571

Authorized Official

Name: SAMANTHA DARLENE HODGE-TRACY, LPC
Title: OWNER/COUNSELOR
Phone: (208) 227-3571

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Mental Health — Mental Health	101YM0800X	Primary

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