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General NPI Number Information
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NPI Number | 1083758585
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE PSYCHOLOGICAL SERVICES, INC
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 04/06/2016
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Provider Practice Location Address
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Address Line | 2525 CAMINO DEL RIO S STE 315
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City | SAN DIEGO
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State | CA
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Zip | 92108-3717
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Country | US
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Telephone | 619-347-3457
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Fax | 619-584-5644
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Provider Business Mailing Address
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Address Line | 2525 CAMINO DEL RIO S STE 315
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City | SAN DIEGO
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State | CA
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Zip | 92108-3717
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Country | US
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Telephone | 619-347-3457
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Fax | 619-584-5644
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. DANIEL JENKINS
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Credential | PH.D.
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Telephone | 619-347-3457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY10627
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License Number State | CA
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