1. Home
  2. Directory
  3. Arkansas
  4. Jacksonville
  5. Clinic Center
  6. NPI Profile
Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 30 days.

LIGHT SOURCE GROUP LLC
NPI 1922832906
Clinic/Center - Mental Health (Including Community Mental Health Center) in Jacksonville, AR

Active since August 30, 2024
625 N 1ST ST STE 200, JACKSONVILLE, AR 72076(501) 985-0292(501) 985-2070 Get Directions Write a Review

NPPES record last updated: July 7, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 7, 2026, Nov 18, 2024 (2 updates tracked since 2024).

About Light Source Group Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

LIGHT SOURCE GROUP LLC (NPI 1922832906) is a healthcare organization registered as a mental health (including community mental health center) in Jacksonville, Arkansas and active in the NPI registry since August 2024. The organization lists Sean Michael Ronnau, Counselor, as its authorized official.

NPPES Registry Identity

NPI1922832906
Entity TypeOrganization
Primary Taxonomy261QM0801X
Legal Business NameLIGHT SOURCE GROUP LLC
Location Address625 N 1ST ST STE 200Jacksonville, AR 72076-4117
Mailing Address116 W Hickory StJacksonville, AR 72076-4420 · (501) 985-0292 · Fax (501) 985-2070
Phone(501) 985-0292
Fax(501) 985-2070
Organization SubpartNo
Authorized OfficialSean Michael RonnauCounselor · (501) 747-0232
Enumeration DateAugust 30, 2024
Last NPPES UpdateJuly 7, 20262 updates tracked since enumeration
NPPES CertifiedJuly 7, 2026
✔ NPI 1922832906 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Mental Health (Including Community Mental Health Center)Ambulatory Health Care Facilities
Taxonomy Code261QM0801X
625 N 1ST ST STE 200, Jacksonville, AR 72076
Open in Google Maps ↗

Other Identifiers 1

Medicaid1093960411AR

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Light Source Group LLC's NPI number?

The NPI number for Light Source Group LLC is 1922832906. It was assigned to this organization in the NPPES registry on August 30, 2024.

Where is Light Source Group LLC located?

Light Source Group LLC is located at 625 N 1st St Ste 200, Jacksonville, AR 72076. The listed phone number is (501) 985-0292.

What is Light Source Group LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Mental Health (Including Community Mental Health Center), with taxonomy code 261QM0801X.

When was this NPI record last updated?

The NPPES record for Light Source Group LLC was last updated on July 7, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 29 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.