Provider Demographics
NPI:1649931817
Name:LIGHTHOUSE COUNSELING, PLLC
Entity type:Organization
Organization Name:LIGHTHOUSE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATHELEEN
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:231-268-1707
Mailing Address - Street 1:PO BOX 794
Mailing Address - Street 2:
Mailing Address - City:INDIAN RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49749-0794
Mailing Address - Country:US
Mailing Address - Phone:231-268-1707
Mailing Address - Fax:
Practice Address - Street 1:3624 S STRAITS HWY # PO794
Practice Address - Street 2:
Practice Address - City:INDIAN RIVER
Practice Address - State:MI
Practice Address - Zip Code:49749-5136
Practice Address - Country:US
Practice Address - Phone:231-268-1707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-10
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI47152575Medicaid