MEDICARE: LIGHTHOUSE CONSULTING SERVICES OF ILLINOIS INC.

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
1	101YP2500X	Professional Counselor	180006525	IL
2	101YP2500X	Professional Counselor	180008164	IL
3	1041C0700X	Clinical Social Worker	149015800	IL
4	2084P0800X	Psychiatry Physician	036046530	IL
5	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1831395672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTHOUSE CONSULTING SERVICES OF ILLINOIS INC.

Provider Business Mailing Address
First Line	:	3205 N WILKE RD STE 112
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-0001
Country	:	US
Telephone Number	:	847-253-9769
Fax Number	:

Provider Business Practice Location Address
First Line	:	3205 N WILKE RD STE 112
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-0001
Country	:	US
Telephone Number	:	847-253-9769
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	DR. RAY KADKHODAIAN
Credential	:	LCPC, PSYD
Telephone Number	:	847-253-9769

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	09/29/2020

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