Provider Demographics
NPI:1164242178
Name:LIGHTHOUSE RECOVERY LLC
Entity type:Organization
Organization Name:LIGHTHOUSE RECOVERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:ALLYSE
Authorized Official - Last Name:BARRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, PMHNP-BC,
Authorized Official - Phone:915-422-2066
Mailing Address - Street 1:1990 E LOHMAN AVE # 117
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3172
Mailing Address - Country:US
Mailing Address - Phone:575-405-0220
Mailing Address - Fax:888-246-6904
Practice Address - Street 1:1990 E LOHMAN AVE STE 117
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3172
Practice Address - Country:US
Practice Address - Phone:915-422-2066
Practice Address - Fax:888-246-6904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-14
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
7L5355OtherMEDICARE
7L6017OtherINDIVIDUAL MEDICARE PTAN
NMN0013372Medicaid
NM29079012Medicaid
NMN0013364Medicaid