Provider Demographics
NPI:1043515422
Name:LIGHTHOUSE COUNSELING
Entity Type:Organization
Organization Name:LIGHTHOUSE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:
Authorized Official - Last Name:WIERS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:860-235-5995
Mailing Address - Street 1:611A LONG HILL RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-4138
Mailing Address - Country:US
Mailing Address - Phone:860-235-5995
Mailing Address - Fax:860-572-4986
Practice Address - Street 1:611A LONG HILL RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4138
Practice Address - Country:US
Practice Address - Phone:860-235-5995
Practice Address - Fax:860-572-4986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-17
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty