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NPI Code Detail

MEDICARE: LIGHTHOUSE PSYCHOLOGY LLC

MEDICARE: LIGHTHOUSE PSYCHOLOGY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist

General Provider Information

NPI Number : 1013565753
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIGHTHOUSE PSYCHOLOGY LLC
Provider Business Mailing Address
First Line : 5635 N SCOTTSDALE RD STE 170
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85250-5945
Country : US
Telephone Number : 480-383-3882
Fax Number :
Provider Business Practice Location Address
First Line : 5635 N SCOTTSDALE RD STE 170
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85250-5945
Country : US
Telephone Number : 480-383-3882
Fax Number :
Authorized Official
Title or Position : CEO
Name : SARETTE A ZECHARIA
Credential : PHD
Telephone Number : 480-383-3882
Provider Enumeration Date : 08/27/2019
Last Update Date : 09/16/2022

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Directions to “LIGHTHOUSE PSYCHOLOGY LLC ” Practice Location

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