Provider Demographics
NPI:1649337338
Name:LIGHTHOUSE OF HOPE COUNSELING CENTER
Entity type:Organization
Organization Name:LIGHTHOUSE OF HOPE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:1408-716-8101
Mailing Address - Street 1:1515 PARTRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-4952
Mailing Address - Country:US
Mailing Address - Phone:140-871-6810
Mailing Address - Fax:408-736-5752
Practice Address - Street 1:1515 PARTRIDGE AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-4952
Practice Address - Country:US
Practice Address - Phone:408-716-8101
Practice Address - Fax:408-736-5752
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-02
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14217305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1649337338OtherBEHAVIORAL HEALTH PROVIDE
CA1649337338OtherSOCIAL SERVICE PROVIDER