Healthcare Provider Details

I. General information

NPI: 1649189507
Provider Name (Legal Business Name): THEE LIGHTHOUSE COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21700 GREENFIELD RD STE 200
OAK PARK MI
48237-2538
US

IV. Provider business mailing address

21700 GREENFIELD RD STE 200
OAK PARK MI
48237-2538
US

V. Phone/Fax

Practice location:
  • Phone: 248-703-2199
  • Fax: 313-580-1822
Mailing address:
  • Phone: 248-703-2199
  • Fax: 313-580-1822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: TONYA KELLEY
Title or Position: PROVIDER
Credential:
Phone: 248-722-5532