Healthcare Provider Details

I. General information

NPI: 1740316058
Provider Name (Legal Business Name): LIGHTHOUSE COUNSELING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 08/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 N ELM ST
HENDERSON KY
42420
US

IV. Provider business mailing address

203 N ELM ST
HENDERSON KY
42420-3132
US

V. Phone/Fax

Practice location:
  • Phone: 270-826-8761
  • Fax: 270-826-8737
Mailing address:
  • Phone: 270-826-8761
  • Fax: 270-826-8737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES C MESSER
Title or Position: ADMINISTRATOR
Credential:
Phone: 270-826-8761