Healthcare Provider Details

I. General information

NPI: 1457189359
Provider Name (Legal Business Name): LIGHTHOUSE COUNSELING, CATHY LIANE, M.S.L.P.,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 COUNTY ROAD 77 STE 2
NISSWA MN
56468-2708
US

IV. Provider business mailing address

PO BOX 68
NISSWA MN
56468-0068
US

V. Phone/Fax

Practice location:
  • Phone: 218-821-4923
  • Fax: 218-961-4923
Mailing address:
  • Phone: 218-821-4923
  • Fax: 218-961-4923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MS. CATHY SUE LIANE
Title or Position: OWNER & LICENSED PSYCHOLOGIST
Credential: MSLP
Phone: 218-821-4923