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	251S00000X	Community/Behavioral Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649931817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTHOUSE COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 794
Second Line	:
City	:	INDIAN RIVER
State	:	MI
Zip	:	49749-0794
Country	:	US
Telephone Number	:	231-268-1707
Fax Number	:

Provider Business Practice Location Address
First Line	:	3624 S STRAITS HWY # PO794
Second Line	:
City	:	INDIAN RIVER
State	:	MI
Zip	:	49749-5136
Country	:	US
Telephone Number	:	231-268-1707
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KATHELEEN JOAN HART
Credential	:	LPC-S
Telephone Number	:	231-268-1707

Provider Enumeration Date	:	01/10/2022
Last Update Date	:	01/10/2022

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Directions to “LIGHTHOUSE COUNSELING, PLLC ” Practice Location

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