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NPI Code Detail

MEDICARE: LIGHTHOUSE MENTAL HEALTH COUNSELING SERVICES, PLLC

MEDICARE: LIGHTHOUSE MENTAL HEALTH COUNSELING 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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
2101YM0800XMental Health Counselor0065091NY

General Provider Information

NPI Number : 1619342839
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIGHTHOUSE MENTAL HEALTH COUNSELING SERVICES, PLLC
Provider Business Mailing Address
First Line : 108 S FRANKLIN AVE
Second Line :
City : VALLEY STREAM
State : NY
Zip : 11580-6105
Country : US
Telephone Number : 516-303-9925
Fax Number : 516-303-9920
Provider Business Practice Location Address
First Line : 108 S FRANKLIN AVE
Second Line :
City : VALLEY STREAM
State : NY
Zip : 11580-6105
Country : US
Telephone Number : 516-303-9925
Fax Number : 516-303-9920
Authorized Official
Title or Position : OWNER
Name : MS. LYNDA SIMON-TAYLOR
Credential : LMHC
Telephone Number : 631-372-0556
Provider Enumeration Date : 12/14/2015
Last Update Date : 08/03/2024

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