Organization
LIGHTHOUSE SUPPORT SERVICES LLC
Active
Organization
LIGHTHOUSE SUPPORT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA EVANS (ADMIN)
(602) 526-0302
Entity
Organization
Contact information
Practice address
7516 E MAIN ST STE 1, MESA, AZ 85207-8332
(602) 526-0302
Mailing address
7516 E MAIN ST STE 1, MESA, AZ 85207-8332
(602) 526-0302
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
—
—
324500000X
Substance Abuse Rehabilitation Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123007
—
AZ
Enumeration date
02/16/2023
Last updated
03/15/2024
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