| Lighthouse Psychiatry Llc | |
|
4001 E Baseline Rd Suite B-7 Gilbert AZ 85234-2726 | |
| (480) 565-6440 | |
| (480) 454-1085 |
| Full Name | Lighthouse Psychiatry Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4001 E Baseline Rd, Gilbert, Arizona |
| Authorized Official Name and Position | Connie Decker (CREDENTIALING MANAGE) |
| Authorized Official Contact | 4802692971 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Psychiatry Llc 4001 E Baseline Rd Suite B-7 Gilbert AZ 85234-2726 Ph: (480) 565-6440 | Lighthouse Psychiatry Llc 4001 E Baseline Rd Suite B-7 Gilbert AZ 85234-2726 Ph: (480) 565-6440 |
| NPI Number | 1326596719 |
|---|---|
| Provider Enumeration Date | 09/14/2016 |
| Last Update Date | 05/17/2022 |
| Certification Date | 05/17/2022 |
| Medicare PECOS PAC ID | 0547545824 |
|---|---|
| Medicare Enrollment ID | O20170329000962 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326596719 | NPI | - | NPPES |
| Provider Name | Waldeck Charles |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1689752123 PECOS PAC ID: 9436101060 Enrollment ID: I20050211000422 |
| Provider Name | Tiffany N Jordan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275779423 PECOS PAC ID: 2668500885 Enrollment ID: I20100510000387 |
| Provider Name | Aida Music |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1285867424 PECOS PAC ID: 3072781905 Enrollment ID: I20110720000823 |
| Provider Name | Amie E Kafer |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1437382736 PECOS PAC ID: 2769646124 Enrollment ID: I20120614000582 |
| Provider Name | Roya Nayeri |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225606460 PECOS PAC ID: 1052709557 Enrollment ID: I20211103000909 |
| Provider Name | Laura Dawn Porter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639877640 PECOS PAC ID: 2769839265 Enrollment ID: I20231106000506 |
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