Healthcare Provider Details

I. General information

NPI: 1922592559
Provider Name (Legal Business Name): LIGHTHOUSE COUNSELING & TESTING SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 SUPERIOR ST STE A
PORT HURON MI
48060
US

IV. Provider business mailing address

805 SUPERIOR ST STE A
PORT HURON MI
48060-3771
US

V. Phone/Fax

Practice location:
  • Phone: 810-996-1972
  • Fax: 810-996-1973
Mailing address:
  • Phone: 810-996-1972
  • Fax: 810-996-1973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LISA GREY
Title or Position: OWNER
Credential:
Phone: 810-996-1972