Provider Demographics
NPI:1093429771
Name:LIGHTHOUSE COUNSELING GROUP LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE COUNSELING GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSILLI
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC, NCC, SAC, A
Authorized Official - Phone:973-400-9117
Mailing Address - Street 1:248 LORRAINE AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1457
Mailing Address - Country:US
Mailing Address - Phone:973-400-9117
Mailing Address - Fax:
Practice Address - Street 1:248 LORRAINE AVE STE 9
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1457
Practice Address - Country:US
Practice Address - Phone:973-400-9117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty