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General NPI Number Information
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NPI Number | 1750584306
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE COUNSELING SERVICES
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Dates
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Enumeration Date | 06/08/2007
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Last Update Date | 06/19/2008
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Provider Practice Location Address
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Address Line | 41690 ENTERPRISE CIR N STE 104
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City | TEMECULA
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State | CA
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Zip | 92590-5617
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Country | US
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Telephone | 951-296-0662
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Fax | 951-296-2114
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Provider Business Mailing Address
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Address Line | 41690 ENTERPRISE CIR N STE 104
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City | TEMECULA
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State | CA
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Zip | 92590-5617
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Country | US
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Telephone | 951-296-0662
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Fax | 951-296-2114
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Authorized Official
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Title or Position | THERAPIST
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Name | JOHN LUCAS
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Credential | MFT
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Telephone | 951-296-0662
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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 | MFT36679
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License Number State | CA
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