Provider Demographics
NPI:1316543408
Name:LIGHTHOUSE THERAPY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:LIGHTHOUSE THERAPY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:GRUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:215-356-0340
Mailing Address - Street 1:123 S BROAD ST STE 2540
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19109-6601
Mailing Address - Country:US
Mailing Address - Phone:215-356-0340
Mailing Address - Fax:
Practice Address - Street 1:123 S BROAD ST STE 2540
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19109-6601
Practice Address - Country:US
Practice Address - Phone:215-356-0340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty