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General NPI Number Information
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NPI Number | 1073495024
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE BEACON, PLLC
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 07/22/2025
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Provider Practice Location Address
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Address Line | 2681 US HIGHWAY 34
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City | OSWEGO
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State | IL
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Zip | 60543-8577
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Country | US
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Telephone | 779-706-1095
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Fax |
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Provider Business Mailing Address
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Address Line | 2560 ROBERT LN
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City | MONTGOMERY
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State | IL
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Zip | 60538-3352
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Country | US
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Telephone | 630-779-2045
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARY MARIE IHNENFELD
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Credential | DSW, LCSW
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Telephone | 630-779-2045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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