Provider Demographics
NPI:1043046121
Name:THE LIGHT WITHIN THERAPY LLC
Entity type:Organization
Organization Name:THE LIGHT WITHIN THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND LMFT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:920-696-8288
Mailing Address - Street 1:3311 SO. PACKERLAND DRIVE
Mailing Address - Street 2:SUITE A#7
Mailing Address - City:DE PERE
Mailing Address - State:WI
Mailing Address - Zip Code:54115
Mailing Address - Country:US
Mailing Address - Phone:920-696-8288
Mailing Address - Fax:
Practice Address - Street 1:3311 SO. PACKERLAND DRIVE
Practice Address - Street 2:SUITE A#7
Practice Address - City:DE PERE
Practice Address - State:WI
Practice Address - Zip Code:54115
Practice Address - Country:US
Practice Address - Phone:920-696-8288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-13
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist