Healthcare Provider Details

I. General information

NPI: 1386036861
Provider Name (Legal Business Name): M. R. LIGHTHOUSE COUNSELING AND CONSULTING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2015
Last Update Date: 02/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

548 W ALEX BELL RD
CENTERVILLE OH
45459-3050
US

IV. Provider business mailing address

548 W ALEX BELL RD
CENTERVILLE OH
45459-3050
US

V. Phone/Fax

Practice location:
  • Phone: 937-239-3465
  • Fax: 937-648-5314
Mailing address:
  • Phone: 937-239-3465
  • Fax: 937-648-5314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. REBECCA ANN STEELE
Title or Position: LICENSED PROFESSIONAL CLINICAL COUN
Credential: LPCC
Phone: 937-239-3465