Provider Demographics
NPI:1427573351
Name:LIGHTHOUSE ABA, PLLC
Entity Type:Organization
Organization Name:LIGHTHOUSE ABA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER & BEHAVIOR ANALYST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:MUMPOWER
Authorized Official - Suffix:
Authorized Official - Credentials:LPA, BCBA
Authorized Official - Phone:910-228-3091
Mailing Address - Street 1:PO BOX 11403
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28404-1403
Mailing Address - Country:US
Mailing Address - Phone:910-228-3091
Mailing Address - Fax:
Practice Address - Street 1:7211 WALKING HORSE CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411-7438
Practice Address - Country:US
Practice Address - Phone:910-228-3091
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1-13-13055103K00000X
NC4583103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty