Provider Demographics
NPI:1124599311
Name:LIGHTHOUSE CHRISTIAN COUNSELING, INC.
Entity Type:Organization
Organization Name:LIGHTHOUSE CHRISTIAN COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:774-285-0822
Mailing Address - Street 1:2514 OAK PARK COURT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1282
Mailing Address - Country:US
Mailing Address - Phone:774-285-0822
Mailing Address - Fax:765-530-8099
Practice Address - Street 1:410 NORTH 10TH STREET
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-3118
Practice Address - Country:US
Practice Address - Phone:774-285-0822
Practice Address - Fax:765-530-8099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty