Organization
LIGHTHOUSE PSYCHIATRY LLC
Active
Organization
LIGHTHOUSE PSYCHIATRY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CONNIE DECKER CPC (CREDENTIALING MANAGE)
(480) 269-2971
Entity
Organization
Contact information
Practice address
4001 E BASELINE RD, SUITE B-7, GILBERT, AZ 85234-2726
(480) 565-6440
(480) 454-1085
Mailing address
4001 E BASELINE RD, SUITE B-7, GILBERT, AZ 85234-2726
(480) 565-6440
(480) 454-1085
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
—
—
207Q00000X
Family Medicine Physician
—
—
207QA0401X
Addiction Medicine (Family Medicine) Physician
—
—
207R00000X
Internal Medicine Physician
—
—
207RA0401X
Addiction Medicine (Internal Medicine) Physician
—
—
208000000X
Pediatrics Physician
—
—
2080A0000X
Pediatric Adolescent Medicine Physician
—
—
2084P0800X
Psychiatry Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
09/14/2016
Last updated
05/17/2022
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