Healthcare Provider Details

I. General information

NPI: 1336982735
Provider Name (Legal Business Name): LYTHOUSE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7002 W WHITEDOVE LN APT 301
MIDDLEBURG HEIGHTS OH
44130-8451
US

IV. Provider business mailing address

7002 W WHITEDOVE LN APT 301
MIDDLEBURG HEIGHTS OH
44130-8451
US

V. Phone/Fax

Practice location:
  • Phone: 330-317-2163
  • Fax:
Mailing address:
  • Phone: 330-317-2163
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH J FATH
Title or Position: FOUNDER/OWNER
Credential: LPCC
Phone: 216-200-7084