MEDICARE: M. R. LIGHTHOUSE COUNSELING AND CONSULTING SERVICES, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YP1600X	Pastoral Counselor
3	101YP2500X	Professional Counselor
4	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1386036861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	M. R. LIGHTHOUSE COUNSELING AND CONSULTING SERVICES, LLC

Provider Business Mailing Address
First Line	:	548 W ALEX BELL RD
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-3050
Country	:	US
Telephone Number	:	937-239-3465
Fax Number	:	937-648-5314

Provider Business Practice Location Address
First Line	:	548 W ALEX BELL RD
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-3050
Country	:	US
Telephone Number	:	937-239-3465
Fax Number	:	937-648-5314

Authorized Official
Title or Position	:	LICENSED PROFESSIONAL CLINICAL COUN
Name	:	MS. REBECCA ANN STEELE
Credential	:	LPCC
Telephone Number	:	937-239-3465

Provider Enumeration Date	:	02/20/2015
Last Update Date	:	02/20/2015

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