Provider Demographics
NPI:1497501621
Name:LIGHTHOUSE COUNSELING LLC
Entity type:Organization
Organization Name:LIGHTHOUSE COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PADEN
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, LMHC
Authorized Official - Phone:509-863-7567
Mailing Address - Street 1:12849 N FARLEY WAY
Mailing Address - Street 2:
Mailing Address - City:RATHDRUM
Mailing Address - State:ID
Mailing Address - Zip Code:83858-0940
Mailing Address - Country:US
Mailing Address - Phone:208-505-8155
Mailing Address - Fax:208-416-6663
Practice Address - Street 1:12849 N FARLEY WAY
Practice Address - Street 2:
Practice Address - City:RATHDRUM
Practice Address - State:ID
Practice Address - Zip Code:83858-0940
Practice Address - Country:US
Practice Address - Phone:208-505-8155
Practice Address - Fax:208-416-6663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-29
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty