Light Source Group LLC
NPI #1922832906 in Jacksonville, Arkansas
Provider Information
- NPI Number
- 1922832906
- Entity Type
- Organization
- Organization Name
- Light Source Group LLC
- Primary Specialty
- Clinic/Center - Mental Health (Including Community Mental Health Center)
- Enumeration Date
- Aug 30, 2024
- Last Updated
- Nov 18, 2024
Practice Location
- Address
- 625 N 1ST ST STE 200
- City
- Jacksonville
- State
- Arkansas
- ZIP Code
- 72076-4117
- Phone
- (501) 985-0292
Authorized Official
- Name
- SEAN MICHAEL RONNAU, LPC
- Title
- COUNSELOR
- Phone
- (501) 747-0232
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Mental Health (Including Community Mental Health Center) — Mental Health (Including Community Mental Health Center) |
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