Provider Demographics
NPI:1235412263
Name:LIGHTHOUSE COUNSELING
Entity Type:Organization
Organization Name:LIGHTHOUSE COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEPPLER
Authorized Official - Suffix:
Authorized Official - Credentials:MALAWCADC
Authorized Official - Phone:270-826-8761
Mailing Address - Street 1:230 2ND ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-3172
Mailing Address - Country:US
Mailing Address - Phone:270-826-8761
Mailing Address - Fax:
Practice Address - Street 1:230 2ND ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-3172
Practice Address - Country:US
Practice Address - Phone:270-826-8761
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY2140104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty