Provider Demographics
NPI:1831944735
Name:LIGHTHOUSE PSYCHOLOGY OF OREGON
Entity type:Organization
Organization Name:LIGHTHOUSE PSYCHOLOGY OF OREGON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCWHIRTER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:541-791-6654
Mailing Address - Street 1:294 ROCKRIDGE LOOP
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-4850
Mailing Address - Country:US
Mailing Address - Phone:541-791-6654
Mailing Address - Fax:
Practice Address - Street 1:175 W B ST STE B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4575
Practice Address - Country:US
Practice Address - Phone:541-791-6654
Practice Address - Fax:541-623-2959
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty