Provider Demographics
NPI:1750584306
Name:LIGHTHOUSE COUNSELING SERVICES
Entity type:Organization
Organization Name:LIGHTHOUSE COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:MFT
Authorized Official - Phone:951-296-0662
Mailing Address - Street 1:41690 ENTERPRISE CIR N STE 104
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-5617
Mailing Address - Country:US
Mailing Address - Phone:951-296-0662
Mailing Address - Fax:951-296-2114
Practice Address - Street 1:41690 ENTERPRISE CIR N STE 104
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-5617
Practice Address - Country:US
Practice Address - Phone:951-296-0662
Practice Address - Fax:951-296-2114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT36679106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty