| 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 | Aaron J Trnka (CEO) |
| Authorized Official Contact | 7637803307 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Psychological Services, Inc. 5155 E River Rd Fridley MN 55421-1025 Ph: (763) 780-3307 | Lighthouse Psychological Services, Inc. 1551 Payne Ave Saint Paul MN 55130-3218 Ph: (763) 780-3077 |
| NPI Number | 1972774834 |
|---|---|
| Provider Enumeration Date | 03/19/2008 |
| Last Update Date | 08/12/2021 |
| Certification Date | 08/12/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972774834 | NPI | - | NPPES |
| 964912100 | Other | MN | MHCP PROVIDER ID # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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