Provider Demographics
NPI:1619342839
Name:LIGHTHOUSE MENTAL HEALTH COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:LIGHTHOUSE MENTAL HEALTH COUNSELING SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON-TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:631-372-0556
Mailing Address - Street 1:9 DONALD LANE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743
Mailing Address - Country:US
Mailing Address - Phone:631-372-0556
Mailing Address - Fax:631-424-0967
Practice Address - Street 1:9 DONALD LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-372-0556
Practice Address - Fax:631-424-0967
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
NY0065091101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty