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Shadow and Light Wellness LLC

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Company Details

Name: Shadow and Light Wellness LLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 18 Jan 2025 (6 months ago)
Financial Date End: 31 Jan 2026
Entity Number: 6074593
Place of Formation: IDAHO
File Number: 973392
ZIP code: 83854
County: Kootenai County
Principal Address: STE B 784 S. CLEARWATER LOOP POST FALLS, ID 83854
Mailing Address: 785 TERRACE DR IDAHO FALLS, ID 83402-3113

Agent

Name Role Address
NORTHWEST REGISTERED AGENT LLC Agent 784 S CLEARWATER LOOP STE B, POST FALLS, ID 83854

National Provider Identifier

NPI Number:
1023823531
Certification Date:
2025-02-11

Authorized Person:

Name:
SAMANTHA DARLENE HODGE-TRACY
Role:
OWNER/COUNSELOR
Phone:

Taxonomy:

Selected Taxonomy:
101YM0800X - Mental Health Counselor
Is Primary:
Yes

Contacts:

Filing

Filing Name Filing Number Filing date
Initial Filing 0006074593 2025-01-18

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Date of last update: 22 Jun 2025

Sources: Idaho Secretary of State