| Lighthouse Mental Health Family Therapy Services | |
|
190 S Orchard Ave Ste A110 Vacaville CA 95688-3649 | |
| (707) 689-5553 | |
| (707) 660-8206 |
| Full Name | Lighthouse Mental Health Family Therapy Services |
|---|---|
| Speciality | Counselor |
| Location | 190 S Orchard Ave Ste A110, Vacaville, California |
| Authorized Official Name and Position | Loletta M Holloway (OWNER) |
| Authorized Official Contact | 7076895553 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Mental Health Family Therapy Services Po Box 1787 Vacaville CA 95696-1787 Ph: (707) 689-5553 | Lighthouse Mental Health Family Therapy Services 190 S Orchard Ave Ste A110 Vacaville CA 95688-3649 Ph: (707) 689-5553 |
| NPI Number | 1669205357 |
|---|---|
| Provider Enumeration Date | 08/20/2024 |
| Last Update Date | 08/20/2024 |
| Certification Date | 08/20/2024 |
| Medicare PECOS PAC ID | 4183155732 |
|---|---|
| Medicare Enrollment ID | O20241007001779 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669205357 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Loletta M Holloway |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1336611458 PECOS PAC ID: 3072044627 Enrollment ID: I20241010003308 |
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