Organization
LIGHTHOUSE CLINICAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BOB GANT PHD (PRESIDENT)
(719) 636-3784
Entity
Organization
Contact information
Practice address
2500 N CIRCLE DR, COLORADO SPRINGS, CO 80909-1184
(719) 636-3784
(719) 630-3211
Mailing address
2500 N CIRCLE DR, COLORADO SPRINGS, CO 80909-1184
(719) 636-3784
(719) 630-3211
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
1788
TX
103G00000X
Clinical Neuropsychologist
Primary
2998
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1788
STATE BOARD OF EXAMINERS
TX
01
—
2998
DORA
CO
Enumeration date
09/07/2007
Last updated
09/07/2007
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