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General NPI Number Information
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NPI Number | 1093477259
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE COUNSELING, LLC
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Dates
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Enumeration Date | 10/06/2021
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Last Update Date | 10/06/2021
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Provider Practice Location Address
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Address Line | 1075 S UTAH AVE STE 356
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City | IDAHO FALLS
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State | ID
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Zip | 83402-3334
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Country | US
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Telephone | 208-541-4295
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Fax |
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Provider Business Mailing Address
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Address Line | 34 N 3600 E
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City | RIGBY
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State | ID
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Zip | 83442-5638
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Country | US
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Telephone | 208-541-4295
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | JODI HYDE
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Credential | LCPC
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Telephone | 208-541-4295
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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