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General NPI Number Information
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NPI Number | 1518535392
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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 | 06/16/2021
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Last Update Date | 06/03/2022
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Provider Practice Location Address
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Address Line | 18 SANTA CRUZ CT
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City | PITTSBURG
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State | CA
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Zip | 94565-2365
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Country | US
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Telephone | 925-706-7270
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 853
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City | PITTSBURG
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State | CA
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Zip | 94565-0085
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Country | US
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Telephone | 925-628-1641
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | PHYLLIS A 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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