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General NPI Number Information
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NPI Number | 1841359270
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE COUNSELING, LTD.
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 04/15/2020
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Provider Practice Location Address
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Address Line | 121 1ST AVE SE
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City | HUTCHINSON
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State | MN
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Zip | 55350-2514
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Country | US
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Telephone | 855-454-2463
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Fax | 320-295-7898
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Provider Business Mailing Address
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Address Line | PO BOX 655
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City | HUTCHINSON
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State | MN
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Zip | 55350-0655
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Country | US
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Telephone | 855-454-2463
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Fax | 320-295-7898
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. LARRY RICHARD BENGTSON
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Credential | M.S.E., L.P.C.C.
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Telephone | 855-454-2463
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CC00105
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License Number State | MN
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