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General NPI Number Information
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NPI Number | 1770326795
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE FAMILY THERAPY
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Dates
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Enumeration Date | 06/17/2024
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Last Update Date | 06/17/2024
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Provider Practice Location Address
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Address Line | 2072 N RED YEARLING DR
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City | SARATOGA SPRINGS
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State | UT
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Zip | 84045-3949
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Country | US
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Telephone | 630-470-1117
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Fax |
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Provider Business Mailing Address
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Address Line | 2072 N RED YEARLING DR
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City | SARATOGA SPRINGS
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State | UT
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Zip | 84045-3949
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Country | US
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Telephone | 630-470-1117
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | CHRISTINA HOLYOAK
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Credential | LMFT
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Telephone | 630-470-1117
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number |
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License Number State |
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