Provider Demographics
NPI:1740029826
Name:LIGHTHOUSE NEUROFEEDBACK & BEHAVIOR ANALYSIS, INC.
Entity type:Organization
Organization Name:LIGHTHOUSE NEUROFEEDBACK & BEHAVIOR ANALYSIS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:HUI-CHUNG
Authorized Official - Middle Name:JACQUELINA
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-295-2291
Mailing Address - Street 1:720 100 YEARPARTY CT STE 200
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-8591
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:216 CHEESMAN ST
Practice Address - Street 2:STE A
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516
Practice Address - Country:US
Practice Address - Phone:720-449-6676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000153728Medicaid