Lighted Path PLLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

LIGHTED PATH PLLC

Practice address

1124 Oak St
Suite 250
Conway, AR 72032-4318

Phone

(804) 592-1205

Fax

(866) 388-8128

NPI assigned

May 4, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jeremy Lynn Dicicco, MA, LAC, CRC

Title

President

Phone

(804) 592-1205

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1272931200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278633600000",
    "number": "1134446958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 224",
            "address_2": "SUITE 250",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720330224",
            "telephone_number": "804-592-1205",
            "fax_number": "866-388-8128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1124 OAK ST",
            "address_2": "SUITE 250",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720324318",
            "telephone_number": "804-592-1205",
            "fax_number": "866-388-8128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTED PATH PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-04",
        "last_updated": "2010-07-09",
        "status": "A",
        "authorized_official_last_name": "DICICCO",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "804-592-1205",
        "authorized_official_credential": "MA, LAC, CRC"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Conway, AR by specialty
• Community/Behavioral Health Agency in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.