Provider Demographics
NPI:1770242737
Name:LIGHTHOUSE THERAPY GROUP, PLLC
Entity Type:Organization
Organization Name:LIGHTHOUSE THERAPY GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MROCZKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, LCPC, LPC
Authorized Official - Phone:239-758-0661
Mailing Address - Street 1:5660 STRAND CT UNIT A180
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-3343
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5660 STRAND CT UNIT A180
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-3343
Practice Address - Country:US
Practice Address - Phone:872-216-3311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-16
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty