Provider Demographics
NPI:1922237270
Name:LIGHTHOUSE PSYCH CONSULTING
Entity Type:Organization
Organization Name:LIGHTHOUSE PSYCH CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-BC
Authorized Official - Phone:678-761-4106
Mailing Address - Street 1:1601 WEHUNT PL SE
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-4845
Mailing Address - Country:US
Mailing Address - Phone:678-761-4106
Mailing Address - Fax:
Practice Address - Street 1:1601 WEHUNT PL SE
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-4845
Practice Address - Country:US
Practice Address - Phone:678-761-4106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN166395-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA269139867BMedicaid
GA50BBHNGMedicare UPIN