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General NPI Number Information
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NPI Number | 1104129287
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 12/13/2010
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Last Update Date | 12/13/2010
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Provider Practice Location Address
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Address Line | 244 E OGDEN AVE SUITE 11
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City | HINSDALE
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State | IL
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Zip | 60521-3648
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Country | US
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Telephone | 630-325-4770
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Fax |
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Provider Business Mailing Address
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Address Line | 244 E OGDEN AVE SUITE 11
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City | HINSDALE
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State | IL
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Zip | 60521-3648
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Country | US
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Telephone | 630-325-4770
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID PRESTON MACKINNON
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Credential | PH.D.
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Telephone | 630-325-4770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166000403
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071004301
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License Number State | IL
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