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General NPI Number Information
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NPI Number | 1699743740
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Entity Type | Organization
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Legal Business Name | THE LIGHTHOUSE, INC.
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 323 N BROAD ST LOWER LEVEL
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City | LANCASTER
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State | OH
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Zip | 43130-3004
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Country | US
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Telephone | 740-687-4423
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Fax | 740-687-1048
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Provider Business Mailing Address
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Address Line | PO BOX 215
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City | LANCASTER
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State | OH
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Zip | 43130-0215
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Country | US
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Telephone | 740-689-2558
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Fax | 740-689-2616
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. SUZANNE PELLETIER-WALKER
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Credential | MSW, LISW
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Telephone | 704-689-2558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MC160400
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License Number State | OH
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