Organization
LIGHTSPACE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JODI LESLIE PH.D, LCPC (PRESIDENT)
(406) 728-1413
Entity
Organization
Contact information
Practice address
1275 BIG FLAT RD, MISSOULA, MT 59804-9217
(406) 728-1413
Mailing address
1275 BIG FLAT RD, MISSOULA, MT 59804-9217
(406) 728-1413
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
960
MT
103T00000X
Psychologist
Primary
115184-2501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000253164
—
MT
01
—
944653
LCPC, BLUE CROSS BLUE SHI
MT
Enumeration date
01/08/2007
Last updated
09/11/2025
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