Organization · Type 2 NPI
Light Source Group LLC
Mental Health Clinic/Center (Including Community Mental Health Center) · Jacksonville, AR
NPI number
1922832906
Active
Practice location
625 N 1st St Ste 200
Jacksonville, AR 72076-4117
Fax (501) 985-2070
Mailing address
116 W Hickory St
Jacksonville, AR 72076-4420
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Mental Health Clinic/Center (Including Community Mental Health Center) Primary | 261QM0801X | None listed |
Mental Health Clinic/Center (Including Community Mental Health Center): Definition to come...
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About NPI 1922832906
Light Source Group LLC's National Provider Identifier is 1922832906, issued on Aug 30, 2024. The primary taxonomy on file is Mental Health Clinic/Center (Including Community Mental Health Center) (261QM0801X), and the practice location is in Jacksonville, AR. The record was last updated on Jul 7, 2026.