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General NPI Number Information
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NPI Number | 1821575655
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE WELLNESS & VITALITY
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Dates
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Enumeration Date | 07/24/2018
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 3580 MYSTIC POINTE DR
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City | AVENTURA
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State | FL
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Zip | 33180-2554
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Country | US
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Telephone | 321-405-3235
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Fax |
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Provider Business Mailing Address
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Address Line | 3201 NE 183RD ST APT 405
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City | AVENTURA
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State | FL
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Zip | 33160-2487
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Country | US
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Telephone | 646-346-4077
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | VANESSA ARANGO
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Credential | LMHC
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Telephone | 646-346-4077
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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 | 15993
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License Number State | FL
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