| Lighthouse Psychological Services Inc | |
|
1551 Payne Ave Saint Paul MN 55130-3218 | |
| (763) 780-3077 | |
| Not Available |
| Full Name | Lighthouse Psychological Services Inc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 1551 Payne Ave, Saint Paul, Minnesota |
| Authorized Official Name and Position | Molly Pavek Olson (CFO) |
| Authorized Official Contact | 7637803307 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Psychological Services Inc 1314 81st Ave Ne Spring Lake Park MN 55432-2116 Ph: () - | Lighthouse Psychological Services Inc 1551 Payne Ave Saint Paul MN 55130-3218 Ph: (763) 780-3077 |
| NPI Number | 1548428170 |
|---|---|
| Provider Enumeration Date | 05/30/2008 |
| Last Update Date | 08/12/2021 |
| Certification Date | 08/12/2021 |
| Medicare PECOS PAC ID | 3072948389 |
|---|---|
| Medicare Enrollment ID | O20200115000170 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548428170 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Daniel Henry |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1861884371 PECOS PAC ID: 4789019092 Enrollment ID: I20200115000264 |
| Provider Name | Sadie Elizabeth Watts |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1093359424 PECOS PAC ID: 6406271014 Enrollment ID: I20200729003911 |
| Provider Name | Cisco Javier Cole |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1063149656 PECOS PAC ID: 9638519846 Enrollment ID: I20240503002414 |
| Provider Name | Nicole Rene Brown |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518729144 PECOS PAC ID: 8628419520 Enrollment ID: I20240509001402 |
| Provider Name | Samantha Nicole Pieper |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649884628 PECOS PAC ID: 2567803828 Enrollment ID: I20240517000218 |
| Provider Name | Jon D. Forsberg |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1609329234 PECOS PAC ID: 4587006051 Enrollment ID: I20240529003028 |
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