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NPI Code Detail

MEDICARE: LIGHTHOUSE CLINICAL COUNSELING AND SPIRITUAL WELLNESS LLC

MEDICARE: LIGHTHOUSE CLINICAL COUNSELING AND SPIRITUAL WELLNESS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP1600XPastoral Counselor
2101YP2500XProfessional Counselor
3104100000XSocial Worker
41041C0700XClinical Social Worker
5106H00000XMarriage & Family Therapist
6171400000XHealth & Wellness Coach
7174400000XSpecialist
8101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1659221034
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIGHTHOUSE CLINICAL COUNSELING AND SPIRITUAL WELLNESS LLC
Provider Business Mailing Address
First Line : 168 DIAMOND WAY
Second Line :
City : CORTLAND
State : OH
Zip : 44410-1399
Country : US
Telephone Number : 330-980-5390
Fax Number :
Provider Business Practice Location Address
First Line : 168 DIAMOND WAY
Second Line :
City : CORTLAND
State : OH
Zip : 44410-1399
Country : US
Telephone Number : 330-980-5390
Fax Number :
Authorized Official
Title or Position : OWNER
Name : ANDREW RYAN
Credential : LPCC-S
Telephone Number : 330-980-5390
Provider Enumeration Date : 02/03/2026
Last Update Date : 02/11/2026

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Directions to “LIGHTHOUSE CLINICAL COUNSELING AND SPIRITUAL WELLNESS LLC ” Practice Location

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