Healthcare Provider Details

I. General information

NPI: 1235216219
Provider Name (Legal Business Name): LIGHTHOUSE COUNSELING, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 06/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 S BROADWAY ST SUITE 2
COAL CITY IL
60416-1699
US

IV. Provider business mailing address

275 S BROADWAY ST SUITE 2
COAL CITY IL
60416-1699
US

V. Phone/Fax

Practice location:
  • Phone: 815-634-3994
  • Fax: 815-634-2738
Mailing address:
  • Phone: 815-634-3994
  • Fax: 815-634-2738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number060007893
License Number StateIL

VIII. Authorized Official

Name: MS. ERICA R. KRAHL
Title or Position: DIRECTOR
Credential: MA, LCPC
Phone: 815-634-3994