Provider Demographics
NPI:1811373434
Name:LIGHTHOUSE COUNSELING
Entity Type:Organization
Organization Name:LIGHTHOUSE COUNSELING
Other - Org Name:LIGHTHOUSE COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIANA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LLPC,CAADP
Authorized Official - Phone:269-408-6031
Mailing Address - Street 1:251 S. STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085
Mailing Address - Country:US
Mailing Address - Phone:269-408-6031
Mailing Address - Fax:
Practice Address - Street 1:251 S. STATE ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085
Practice Address - Country:US
Practice Address - Phone:269-408-6031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401014597251S00000X
MI6401012473251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1265848147Medicaid
MI1154698793Medicaid