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General NPI Number Information
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NPI Number | 1770242737
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE THERAPY GROUP, PLLC
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Dates
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Enumeration Date | 12/16/2021
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Last Update Date | 12/04/2023
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Provider Practice Location Address
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Address Line | 5660 STRAND CT UNIT A180
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City | NAPLES
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State | FL
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Zip | 34110-3343
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Country | US
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Telephone | 872-216-3311
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Fax |
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Provider Business Mailing Address
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Address Line | 5660 STRAND CT UNIT A180
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City | NAPLES
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State | FL
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Zip | 34110-3343
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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/ OWNER
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Name | TAYLOR MROCZKOWSKI
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Credential | LMHC, LCPC, LPC
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Telephone | 239-758-0661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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