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General NPI Number Information
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NPI Number | 1114805926
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Entity Type | Organization
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Legal Business Name | THE LIGHTHOUSE MENTORING CENTER
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Dates
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Enumeration Date | 08/21/2025
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 5453 SHRIKE WAY
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City | ANTIOCH
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State | CA
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Zip | 94531-7821
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Country | US
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Telephone | 925-350-0149
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Fax | 925-350-0158
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Provider Business Mailing Address
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Address Line | 5453 SHRIKE WAY
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City | ANTIOCH
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State | CA
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Zip | 94531-7821
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Country | US
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Telephone | 925-350-0149
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Fax | 925-350-0158
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | PHYLLIS RITTER
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Credential | LMFT
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Telephone | 925-628-1641
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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