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General NPI Number Information
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NPI Number | 1649337338
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE OF HOPE COUNSELING CENTER
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 05/20/2010
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Provider Practice Location Address
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Address Line | 1515 PARTRIDGE AVE
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City | SUNNYVALE
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State | CA
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Zip | 94087-4952
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Country | US
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Telephone | 408-716-8101
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Fax | 408-736-5752
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Provider Business Mailing Address
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Address Line | 1515 PARTRIDGE AVE
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City | SUNNYVALE
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State | CA
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Zip | 94087-4952
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Country | US
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Telephone | 140-871-6810
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Fax | 408-736-5752
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MRS. GLORIA JEAN BAXTER
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Credential | LCSW
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Telephone | 14087168101
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | 14217
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License Number State | CA
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