Provider Demographics
NPI:1184216590
Name:LIGHTHOUSE MENTAL HEALTH COUNSELING, LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE MENTAL HEALTH COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:BORUM
Authorized Official - Last Name:WARRINER
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC-S
Authorized Official - Phone:859-957-6067
Mailing Address - Street 1:2390 PRESERVATION WAY
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-7879
Mailing Address - Country:US
Mailing Address - Phone:859-957-6067
Mailing Address - Fax:
Practice Address - Street 1:2390 PRESERVATION WAY
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-7879
Practice Address - Country:US
Practice Address - Phone:804-240-0618
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-07
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100726530Medicaid