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General NPI Number Information
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NPI Number | 1407902109
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE PROFESSIONAL CLINIC, P.C.
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 06/05/2008
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Provider Practice Location Address
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Address Line | 409 W LUDINGTON AVE STE 307
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City | LUDINGTON
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State | MI
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Zip | 49431-2377
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Country | US
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Telephone | 231-843-8877
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Fax | 231-845-0264
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Provider Business Mailing Address
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Address Line | 409 W LUDINGTON AVE STE 307
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City | LUDINGTON
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State | MI
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Zip | 49431-2377
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Country | US
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Telephone | 231-843-8877
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Fax | 231-845-0264
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Authorized Official
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Title or Position | OWNER
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Name | STANLEY L SEUFERER
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Credential | D.O.
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Telephone | 231-843-8877
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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 | MI
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Taxonomy #2
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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 | MI
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