Provider Demographics
NPI:1578257150
Name:LIGHTHOUSE COUNSELING AND FAMILY RESOURCE CENTER
Entity Type:Organization
Organization Name:LIGHTHOUSE COUNSELING AND FAMILY RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-312-1234
Mailing Address - Street 1:110 GATEWAY DR STE 210
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-3306
Mailing Address - Country:US
Mailing Address - Phone:530-312-1234
Mailing Address - Fax:
Practice Address - Street 1:3175 SUNSET BLVD STE 103
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-3091
Practice Address - Country:US
Practice Address - Phone:916-645-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty