Provider Demographics
NPI:1427413657
Name:LIGHTHOUSE COUNSELING ASSOCIATES
Entity Type:Organization
Organization Name:LIGHTHOUSE COUNSELING ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:JUDETH
Authorized Official - Last Name:COSTELLO ATHERTON-ELY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:570-562-1166
Mailing Address - Street 1:812 S MAIN ST
Mailing Address - Street 2:P.O. BOX 35
Mailing Address - City:TAYLOR
Mailing Address - State:PA
Mailing Address - Zip Code:18517-1828
Mailing Address - Country:US
Mailing Address - Phone:570-562-1166
Mailing Address - Fax:570-457-3779
Practice Address - Street 1:812 S MAIN ST
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:PA
Practice Address - Zip Code:18517-1828
Practice Address - Country:US
Practice Address - Phone:570-562-1166
Practice Address - Fax:570-457-3779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA357033251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health