Provider Demographics
NPI:1215022041
Name:THE COMMUNITY LIGHTHOUSE
Entity Type:Organization
Organization Name:THE COMMUNITY LIGHTHOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:PIERCE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FERRIEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-273-6300
Mailing Address - Street 1:7801 ACADEMY RD NE STE 2-200
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3380
Mailing Address - Country:US
Mailing Address - Phone:505-273-6300
Mailing Address - Fax:505-265-7860
Practice Address - Street 1:7801 ACADEMY RD NE STE 2-200
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3380
Practice Address - Country:US
Practice Address - Phone:505-262-9391
Practice Address - Fax:505-265-7860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM101Y00000X, 106H00000X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM46984879Medicaid