Organization
LIGHTHOUSE PSYCHOLOGICAL SERVICES, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AARON J TRNKA M.A. (CEO)
(763) 780-3307
Entity
Organization
Contact information
Practice address
1551 PAYNE AVE, SAINT PAUL, MN 55130-3218
(763) 780-3077
Mailing address
5155 E RIVER RD, FRIDLEY, MN 55421-1025
(763) 780-3307
(763) 780-3306
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
964912100
MHCP PROVIDER ID #
MN
Enumeration date
03/19/2008
Last updated
08/12/2021
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