MEDICARE: LIGHTHOUSE COUNSELING & PSYCHOLOGICAL SERVICES, 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	103TC0700X	Clinical Psychologist	PY00002703	WA
2	103TC2200X	Clinical Child & Adolescent Psychologist	PY00002703	WA
3	1041C0700X	Clinical Social Worker	LW00004172	WA

General Provider Information

NPI Number	:	1265527360
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTHOUSE COUNSELING & PSYCHOLOGICAL SERVICES, PLLC

Provider Business Mailing Address
First Line	:	8623-B NORTH DIVISION
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99208
Country	:	US
Telephone Number	:	509-466-4363
Fax Number	:	509-466-4364

Provider Business Practice Location Address
First Line	:	8623-B NORTH DIVISION
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99208
Country	:	US
Telephone Number	:	509-466-4363
Fax Number	:	509-466-4364

Authorized Official
Title or Position	:	OWNER/OFFICE MANGAGER
Name	:	LESLIE G BROST
Credential	:	PSYD
Telephone Number	:	509-466-4363

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	09/11/2025

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