Healthcare Provider Details

I. General information

NPI: 1841359270
Provider Name (Legal Business Name): LIGHTHOUSE COUNSELING, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 1ST AVE SE
HUTCHINSON MN
55350-2514
US

IV. Provider business mailing address

PO BOX 655
HUTCHINSON MN
55350-0655
US

V. Phone/Fax

Practice location:
  • Phone: 855-454-2463
  • Fax: 320-295-7898
Mailing address:
  • Phone: 855-454-2463
  • Fax: 320-295-7898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC00105
License Number StateMN

VIII. Authorized Official

Name: MR. LARRY RICHARD BENGTSON
Title or Position: PRESIDENT
Credential: M.S.E., L.P.C.C.
Phone: 855-454-2463