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General NPI Number Information
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NPI Number | 1710708110
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 410 MAIN ST W STE C
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City | HARTSELLE
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State | AL
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Zip | 35640-2428
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Country | US
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Telephone | 256-502-5116
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 55
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City | HARTSELLE
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State | AL
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Zip | 35640-0055
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | STEPHANIE KENNEY
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Credential |
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Telephone | 256-736-3746
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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 |
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