Provider Demographics
NPI:1003232547
Name:LIGHTHOUSE FAMILY COUNSELING INC.
Entity Type:Organization
Organization Name:LIGHTHOUSE FAMILY COUNSELING INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:BRAWLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT (MFC 36541)
Authorized Official - Phone:949-285-8802
Mailing Address - Street 1:3742 CARMEL AVE.
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606
Mailing Address - Country:US
Mailing Address - Phone:949-285-8802
Mailing Address - Fax:949-679-8929
Practice Address - Street 1:1440 N. HARBOR BLVD.
Practice Address - Street 2:SUITE 908
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92838
Practice Address - Country:US
Practice Address - Phone:949-285-8802
Practice Address - Fax:949-679-8929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36541106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty