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General NPI Number Information
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NPI Number | 1295626182
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE NEUROFEEDBACK & BEHAVIOR ANALYSIS, INC.
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Dates
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Enumeration Date | 07/10/2025
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 12213 PECOS ST STE 500
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City | DENVER
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State | CO
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Zip | 80234-3416
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Country | US
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Telephone | 720-449-6676
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Fax | 303-374-5224
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Provider Business Mailing Address
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Address Line | 720 100 YEARPARTY CT STE 200
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City | LONGMONT
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State | CO
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Zip | 80504-8591
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Country | US
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Telephone | 720-449-6676
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Fax | 303-374-5224
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | HUI-CHUNG JACQUELINA KING
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Credential |
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Telephone | 720-295-2291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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