Healthcare Provider Details

I. General information

NPI: 1235774589
Provider Name (Legal Business Name): LIGHTHOUSE COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2019
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 HIGHWAY 90
BAY SAINT LOUIS MS
39520-2832
US

IV. Provider business mailing address

303 HIGHWAY 90
BAY SAINT LOUIS MS
39520-2832
US

V. Phone/Fax

Practice location:
  • Phone: 228-238-0992
  • Fax:
Mailing address:
  • Phone: 228-238-0992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA JAMES
Title or Position: OWNER
Credential:
Phone: 228-238-0992