Healthcare Provider Details

I. General information

NPI: 1619342839
Provider Name (Legal Business Name): LIGHTHOUSE MENTAL HEALTH COUNSELING SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2015
Last Update Date: 08/03/2024
Certification Date: 08/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S FRANKLIN AVE
VALLEY STREAM NY
11580-6105
US

IV. Provider business mailing address

108 S FRANKLIN AVE
VALLEY STREAM NY
11580-6105
US

V. Phone/Fax

Practice location:
  • Phone: 516-303-9925
  • Fax: 516-303-9920
Mailing address:
  • Phone: 516-303-9925
  • Fax: 516-303-9920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0065091
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. LYNDA SIMON-TAYLOR
Title or Position: OWNER
Credential: LMHC
Phone: 631-372-0556