Provider Demographics
NPI:1821575655
Name:LIGHTHOUSE WELLNESS & VITALITY
Entity Type:Organization
Organization Name:LIGHTHOUSE WELLNESS & VITALITY
Other - Org Name:LIGHTHOUSE WELLNESS & VITALITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARANGO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:646-346-4077
Mailing Address - Street 1:3201 NE 183RD ST APT 405
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2487
Mailing Address - Country:US
Mailing Address - Phone:646-346-4077
Mailing Address - Fax:
Practice Address - Street 1:3580 MYSTIC POINTE DR
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2554
Practice Address - Country:US
Practice Address - Phone:321-405-3235
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15993101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty