Provider Demographics
NPI:1164073086
Name:LIGHTHOUSE COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:LIGHTHOUSE COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:JANEEN
Authorized Official - Last Name:DA SILVA
Authorized Official - Suffix:
Authorized Official - Credentials:CMHC
Authorized Official - Phone:385-237-4943
Mailing Address - Street 1:3409 W 12600 S STE 110
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-7270
Mailing Address - Country:US
Mailing Address - Phone:385-237-4943
Mailing Address - Fax:385-259-1035
Practice Address - Street 1:3409 W 12600 S STE 110
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84065-7270
Practice Address - Country:US
Practice Address - Phone:385-237-4943
Practice Address - Fax:385-259-1035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1477836369OtherNPI
UT1407116833OtherNPI