Healthcare Provider Details

I. General information

NPI: 1396244125
Provider Name (Legal Business Name): LIGHTHOUSE FAMILY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2018
Last Update Date: 06/11/2020
Certification Date: 06/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 EXTON CMNS
EXTON PA
19341-2450
US

IV. Provider business mailing address

306 EXTON CMNS
EXTON PA
19341-2450
US

V. Phone/Fax

Practice location:
  • Phone: 610-968-1236
  • Fax: 610-968-1236
Mailing address:
  • Phone: 610-968-1236
  • Fax: 610-968-1236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KATHERINE ELLEN GOREE
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: MA, LPC, NCC
Phone: 610-968-1236