Light Source Group LLC
Light Source Group LLC is a healthcare organization registered as Mental Health Clinic/Center (Including Community Mental Health Center) in Jacksonville, AR, holding Type 2 (organization) NPI 1922832906 since 2024. The authorized official on file is Sean Ronnau, Counselor.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1922832906 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Light Source Group LLC |
| Practice address | 625 N 1ST ST STE 200, Jacksonville, AR, 72076 |
| Phone | 5019850292 |
| Fax | 5019852070 |
| Enumeration date | 2024-08-30 |
| Last updated in NPPES | 2024-11-18 |
Authorized official
| Name | Sean Ronnau |
|---|---|
| Title | Counselor |
| Phone | 5017470232 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | Primary | — | — |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093960411 | Medicaid | AR | — |
Copy-ready billing details
Provider: Light Source Group LLC NPI: 1922832906 Taxonomy: 261QM0801X (Mental Health Clinic/Center (Including Community Mental Health Center)) Address: 625 N 1ST ST STE 200, Jacksonville, AR, 72076
Verify this record
Cross-check NPI 1922832906 against the authoritative CMS record: view Light Source Group LLC on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
What is the NPI number for Light Source Group LLC?
Who is the authorized official for Light Source Group LLC?
Source: CMS NPPES (public data). Snapshot 2026-07-10. Provider record last updated 2024-11-18.