Provider Demographics
NPI:1578227112
Name:LIGHTHOUSE THERAPY
Entity Type:Organization
Organization Name:LIGHTHOUSE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:THURWACHTER-KING
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:551-327-9077
Mailing Address - Street 1:6 FULTON ST APT 2
Mailing Address - Street 2:
Mailing Address - City:WEEHAWKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07086-7407
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6 FULTON ST APT 2
Practice Address - Street 2:
Practice Address - City:WEEHAWKEN
Practice Address - State:NJ
Practice Address - Zip Code:07086-7407
Practice Address - Country:US
Practice Address - Phone:551-327-9077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health