Healthcare Provider Details

I. General information

NPI: 1124867320
Provider Name (Legal Business Name): LIGHTHOUSE THERAPIES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2024
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4779 KERRY ANN PL
LAS CRUCES NM
88012-7474
US

IV. Provider business mailing address

4779 KERRY ANN PL
LAS CRUCES NM
88012-7474
US

V. Phone/Fax

Practice location:
  • Phone: 575-223-2449
  • Fax:
Mailing address:
  • Phone: 915-274-0372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CELINA JO HOLGUIN
Title or Position: OWNER/THERAPIST
Credential: LCSW
Phone: 915-274-0372