Provider Demographics
NPI:1659720332
Name:LIGHTHOUSE PROFESSIONAL COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE PROFESSIONAL COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:FILMORE
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LCPC
Authorized Official - Phone:773-656-2738
Mailing Address - Street 1:2535 BETHANY RD
Mailing Address - Street 2:STE 210
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3126
Mailing Address - Country:US
Mailing Address - Phone:773-656-2738
Mailing Address - Fax:
Practice Address - Street 1:2535 BETHANY RD
Practice Address - Street 2:STE 210
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3126
Practice Address - Country:US
Practice Address - Phone:773-656-2738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2016-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180008697251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health