Healthcare Provider Details

I. General information

NPI: 1043101199
Provider Name (Legal Business Name): LIGHTHOUSE NEUROFEEDBACK & BEHAVIOR ANALYSIS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 SUNSET PL STE A
LONGMONT CO
80501-6545
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: 303-374-5224
Mailing address:
  • Phone: 720-449-6676
  • Fax: 303-374-5224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
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