Provider Demographics
NPI:1861558983
Name:LIGHTHOUSE COUNSELING OF LAKE COUNTY INC.
Entity type:Organization
Organization Name:LIGHTHOUSE COUNSELING OF LAKE COUNTY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BRETTHAUER
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:847-347-7367
Mailing Address - Street 1:329 KENLOCH AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-1771
Mailing Address - Country:US
Mailing Address - Phone:847-347-7367
Mailing Address - Fax:224-513-4700
Practice Address - Street 1:505 E HAWLEY ST
Practice Address - Street 2:SUITE 140
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-2494
Practice Address - Country:US
Practice Address - Phone:847-347-7367
Practice Address - Fax:224-513-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-01
Last Update Date:2012-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180005594101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty