Provider Demographics
NPI:1356958672
Name:LIGHTHOUSE PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:LIGHTHOUSE PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:ECKSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:541-817-3824
Mailing Address - Street 1:2800 N LOMBARD STREET
Mailing Address - Street 2:STE. 153
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217
Mailing Address - Country:US
Mailing Address - Phone:541-817-3824
Mailing Address - Fax:503-389-7945
Practice Address - Street 1:630 SW NEVADA ST
Practice Address - Street 2:STE. E
Practice Address - City:PORALND
Practice Address - State:OR
Practice Address - Zip Code:97219
Practice Address - Country:US
Practice Address - Phone:541-817-3824
Practice Address - Fax:503-389-7945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty