Healthcare Provider Details

I. General information

NPI: 1740029826
Provider Name (Legal Business Name): LIGHTHOUSE NEUROFEEDBACK & BEHAVIOR ANALYSIS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 CHEESMAN ST STE A
ERIE CO
80516
US

IV. Provider business mailing address

720 100 YEARPARTY CT STE 200
LONGMONT CO
80504-8591
US

V. Phone/Fax

Practice location:
  • Phone: 720-449-6676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: HUI-CHUNG JACQUELINA KING
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 720-295-2291