| Lighthouse Support Services Llc | |
|
7516 E Main St Ste 1 Mesa AZ 85207-8332 | |
| (602) 526-0302 | |
| Not Available |
| Full Name | Lighthouse Support Services Llc |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 7516 E Main St Ste 1, Mesa, Arizona |
| Authorized Official Name and Position | Jessica Evans (ADMIN) |
| Authorized Official Contact | 6025260302 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Support Services Llc 7516 E Main St Ste 1 Mesa AZ 85207-8332 Ph: (602) 526-0302 | Lighthouse Support Services Llc 7516 E Main St Ste 1 Mesa AZ 85207-8332 Ph: (602) 526-0302 |
| NPI Number | 1033817333 |
|---|---|
| Provider Enumeration Date | 02/16/2023 |
| Last Update Date | 03/15/2024 |
| Certification Date | 12/15/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033817333 | NPI | - | NPPES |
| 123007 | Medicaid | AZ |
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