Provider Demographics
NPI:1235569476
Name:LIGHTHOUSE COUNSELING SERVICES LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:612-382-5608
Mailing Address - Street 1:7132 MORGAN AVE S
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2938
Mailing Address - Country:US
Mailing Address - Phone:612-382-5608
Mailing Address - Fax:651-528-6400
Practice Address - Street 1:1935 COUNTY RD B2
Practice Address - Street 2:
Practice Address - City:ROSEVILE
Practice Address - State:MN
Practice Address - Zip Code:55113-2703
Practice Address - Country:US
Practice Address - Phone:612-382-5608
Practice Address - Fax:651-528-6400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1221106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty