Provider Demographics
NPI:1831395672
Name:LIGHTHOUSE CONSULTING SERVICES OF ILLINOIS INC.
Entity type:Organization
Organization Name:LIGHTHOUSE CONSULTING SERVICES OF ILLINOIS INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RAY
Authorized Official - Middle Name:
Authorized Official - Last Name:KADKHODAIAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC, PSYD
Authorized Official - Phone:847-253-9769
Mailing Address - Street 1:3205 N WILKE RD STE 112
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-0001
Mailing Address - Country:US
Mailing Address - Phone:847-253-9769
Mailing Address - Fax:
Practice Address - Street 1:3205 N WILKE RD STE 112
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-0001
Practice Address - Country:US
Practice Address - Phone:847-253-9769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180006525101YP2500X
IL180008164101YP2500X
IL1490158001041C0700X
IL0360465302084P0800X
101YP2500X
IL360465302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty