Provider Demographics
NPI:1659880946
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:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:DUELL-STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:916-408-6618
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:916-645-3300
Mailing Address - Fax:916-645-3311
Practice Address - Street 1:110 GATEWAY DR STE 210
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648
Practice Address - Country:US
Practice Address - Phone:916-645-3300
Practice Address - Fax:916-645-3311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 251S00000X
CALMFT97103106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1255844361Medicaid
CA1952825788Medicaid
CA1609166750Medicaid
CA1326387747Medicaid
CA1962554360Medicaid
CA1447465448Medicaid