| Lighthouse Neurofeedback & Behavior Analysis, Inc. | |
|
3080 Valmont Rd Ste 220 Boulder CO 80301-2152 | |
| (720) 772-7334 | |
| (303) 833-4217 |
| Full Name | Lighthouse Neurofeedback & Behavior Analysis, Inc. |
|---|---|
| Speciality | Behavior Analyst |
| Location | 3080 Valmont Rd Ste 220, Boulder, Colorado |
| Authorized Official Name and Position | Remy Loeb-willer (CLINIC MANAGER) |
| Authorized Official Contact | 7204496676 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Neurofeedback & Behavior Analysis, Inc. Po Box 516 Dacono CO 80514-0516 Ph: (720) 449-6676 | Lighthouse Neurofeedback & Behavior Analysis, Inc. 3080 Valmont Rd Ste 220 Boulder CO 80301-2152 Ph: (720) 772-7334 |
| NPI Number | 1972010064 |
|---|---|
| Provider Enumeration Date | 01/10/2018 |
| Last Update Date | 01/10/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972010064 | NPI | - | NPPES |
| 9000153728 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 0011628 (Colorado) | Secondary |
| 103K00000X | Behavior Analyst | 1-09-5794 (* (Not Available)) | Primary |
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