MEDICARE: LIGHTHOUSE COUNSELING PLLC

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
1	1041C0700X	Clinical Social Worker	51898	TX

General Provider Information

NPI Number	:	1194251694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTHOUSE COUNSELING PLLC

Provider Business Mailing Address
First Line	:	3008 DAWN DR STE 101
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78628-2822
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3008 DAWN DR STE 101
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78628-2822
Country	:	US
Telephone Number	:	512-763-2751
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MICHELLE GERBOZY
Credential	:
Telephone Number	:	512-763-2751

Provider Enumeration Date	:	05/04/2017
Last Update Date	:	03/17/2018

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Directions to “LIGHTHOUSE COUNSELING PLLC ” Practice Location

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