Organization
LIGHTHOUSE BEHAVIORAL HEALTH, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRUCE PATRICK HACKWORTH PH.D. (OWNER/LICENSED PSYCHOLOGIST)
(269) 985-3618
Entity
Organization
Contact information
Practice address
811 SHIP ST, SUITE 4B, SAINT JOSEPH, MI 49085-1171
(269) 985-3618
(269) 609-6009
Mailing address
811 SHIP ST, SUITE 4B, SAINT JOSEPH, MI 49085-1171
(269) 985-3618
(269) 609-6009
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
6301006344
MI
Other
Enumeration date
06/09/2015
Last updated
06/09/2015
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