Provider Demographics
NPI:1033597315
Name:LIGHTHOUSE COUNSELING LLP
Entity Type:Organization
Organization Name:LIGHTHOUSE COUNSELING LLP
Other - Org Name:LIGHTHOUSE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:VINEESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RATHNAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-408-6031
Mailing Address - Street 1:521 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085-1369
Mailing Address - Country:US
Mailing Address - Phone:269-408-6031
Mailing Address - Fax:269-408-6031
Practice Address - Street 1:521 STATE ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-1369
Practice Address - Country:US
Practice Address - Phone:269-408-6031
Practice Address - Fax:269-408-6031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014597101Y00000X
MI6401012473101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1265848147Medicaid
MI1154698793Medicaid