Provider Demographics
NPI:1003218546
Name:LIGHTHOUSE PROFESSIONAL COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:LIGHTHOUSE PROFESSIONAL COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR/CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORA
Authorized Official - Middle Name:K
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:606-834-0020
Mailing Address - Street 1:1100 OUR LADY'S WAY STE 219
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7049
Mailing Address - Country:US
Mailing Address - Phone:606-834-0020
Mailing Address - Fax:606-834-0049
Practice Address - Street 1:1100 OUR LADY'S WAY STE 219
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7049
Practice Address - Country:US
Practice Address - Phone:606-834-0020
Practice Address - Fax:606-834-0049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101YA0400X, 101YM0800X, 101YP2500X, 1041C0700X, 101YA0400X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100442620Medicaid