Provider Demographics
NPI:1326268103
Name:LIGHTHOUSE COUNSELING & SAND PLAY TRAINING CENTER, LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE COUNSELING & SAND PLAY TRAINING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LCSW
Authorized Official - Phone:732-380-1575
Mailing Address - Street 1:615 HOPE RD
Mailing Address - Street 2:BUILDING 3A
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-1277
Mailing Address - Country:US
Mailing Address - Phone:732-380-1575
Mailing Address - Fax:732-380-1578
Practice Address - Street 1:615 HOPE RD
Practice Address - Street 2:BUILDING 3A
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-1277
Practice Address - Country:US
Practice Address - Phone:732-380-1575
Practice Address - Fax:732-380-1578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC049714001041C0700X, 1041C0700X
NJ44SC045976001041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ200856282Medicare UPIN