Healthcare Provider Details

I. General information

NPI: 1104950229
Provider Name (Legal Business Name): LIGHTHOUSE COUNSELING CENTER, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2912 KING ST
JONESBORO AR
72401-5321
US

IV. Provider business mailing address

2912 KING ST
JONESBORO AR
72401-5321
US

V. Phone/Fax

Practice location:
  • Phone: 870-910-3757
  • Fax: 870-910-4999
Mailing address:
  • Phone: 870-910-3757
  • Fax: 870-910-4999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP9605014
License Number StateAR

VIII. Authorized Official

Name: DR. DAN HOLMES
Title or Position: DIRECTOR
Credential: PH.D.
Phone: 870-910-3757