Healthcare Provider Details

I. General information

NPI: 1124599311
Provider Name (Legal Business Name): LIGHTHOUSE CHRISTIAN COUNSELING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 QUAKER HILL DR
RICHMOND IN
47374-1926
US

IV. Provider business mailing address

2514 OAK PARK COURT
RICHMOND IN
47374-1282
US

V. Phone/Fax

Practice location:
  • Phone: 774-285-0822
  • Fax: 765-966-1293
Mailing address:
  • Phone: 774-285-0822
  • Fax: 765-966-1293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH JANE MOORE
Title or Position: PRESIDENT
Credential: PMHNP-BC
Phone: 774-285-0822