Healthcare Provider Details

I. General information

NPI: 1144151408
Provider Name (Legal Business Name): LIGHTHOUSE WELLNESS & RECOVERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 DORBETT ST
JASPER IN
47546-2619
US

IV. Provider business mailing address

1043 DORBETT ST
JASPER IN
47546-2619
US

V. Phone/Fax

Practice location:
  • Phone: 502-430-2041
  • Fax:
Mailing address:
  • Phone: 812-580-9285
  • Fax: 812-269-1756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER L SHEROHMAN
Title or Position: OWNER
Credential: APRN
Phone: 812-580-9285