Provider Demographics
NPI:1013565753
Name:LIGHTHOUSE PSYCHOLOGY LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE PSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SARETTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZECHARIA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:480-383-3882
Mailing Address - Street 1:5635 N SCOTTSDALE RD STE 170
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-5945
Mailing Address - Country:US
Mailing Address - Phone:480-383-3882
Mailing Address - Fax:
Practice Address - Street 1:5635 N SCOTTSDALE RD STE 170
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-5945
Practice Address - Country:US
Practice Address - Phone:480-383-3882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-27
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty