Healthcare Provider Details

I. General information

NPI: 1891622833
Provider Name (Legal Business Name): LIGHTHOUSE FAMILY THERAPY PROF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 OAKRIDGE DR UNIT 105
FORT COLLINS CO
80525-9651
US

IV. Provider business mailing address

1785 NIGHTFALL DR
WINDSOR CO
80550-3489
US

V. Phone/Fax

Practice location:
  • Phone: 970-460-6762
  • Fax: 970-680-7250
Mailing address:
  • Phone: 970-460-6762
  • Fax: 970-680-7250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER N BERGIN
Title or Position: OWNER
Credential: LPC
Phone: 303-929-6743