| Lighthouse Therapy Services Llc | |
|
100 W Main St Ste 204 Saint Clairsville OH 43950-1265 | |
| (304) 408-3587 | |
| Not Available |
| Full Name | Lighthouse Therapy Services Llc |
|---|---|
| Speciality | Social Worker |
| Location | 100 W Main St Ste 204, Saint Clairsville, Ohio |
| Authorized Official Name and Position | Evelyn Scott (CREDENTIALING) |
| Authorized Official Contact | 4042135329 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Therapy Services Llc 100 W Main St Ste 204 Saint Clairsville OH 43950-1265 Ph: (404) 213-5329 | Lighthouse Therapy Services Llc 100 W Main St Ste 204 Saint Clairsville OH 43950-1265 Ph: (304) 408-3587 |
| NPI Number | 1558085506 |
|---|---|
| Provider Enumeration Date | 10/03/2022 |
| Last Update Date | 03/04/2023 |
| Certification Date | 03/04/2023 |
| Medicare PECOS PAC ID | 8426494097 |
|---|---|
| Medicare Enrollment ID | O20240306002256 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558085506 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kaci Wisvari |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1265953871 PECOS PAC ID: 9335585900 Enrollment ID: I20240306002293 |
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