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General NPI Number Information
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NPI Number | 1578336020
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 11/06/2023
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Last Update Date | 11/06/2023
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Provider Practice Location Address
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Address Line | 1320 N CAMPBELL RD STE 13
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City | ROYAL OAK
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State | MI
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Zip | 48067-1555
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Country | US
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Telephone | 850-766-6534
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Fax |
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Provider Business Mailing Address
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Address Line | 1818 E HUDSON AVE
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City | ROYAL OAK
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State | MI
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Zip | 48067-3591
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Country | US
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Telephone | 850-766-6534
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHANCHAL TANDON
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Credential | LMFT
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Telephone | 850-766-6534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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