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General NPI Number Information
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NPI Number | 1326596719
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE PSYCHIATRY LLC
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Dates
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Enumeration Date | 09/14/2016
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 4001 E BASELINE RD SUITE B-7
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City | GILBERT
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State | AZ
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Zip | 85234-2726
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Country | US
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Telephone | 480-565-6440
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Fax | 480-454-1085
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Provider Business Mailing Address
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Address Line | 4001 E BASELINE RD SUITE B-7
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City | GILBERT
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State | AZ
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Zip | 85234-2726
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Country | US
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Telephone | 480-565-6440
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Fax | 480-454-1085
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Authorized Official
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Title or Position | CREDENTIALING MANAGE
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Name | CONNIE DECKER
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Credential | CPC
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Telephone | 480-269-2971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #11
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #12
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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