| Lighthousetherapy, Llc | |
|
1777 S Harrison St Ste 1200 Denver CO 80210-3955 | |
| (833) 749-3549 | |
| (303) 376-4347 |
| Full Name | Lighthousetherapy, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1777 S Harrison St Ste 1200, Denver, Colorado |
| Authorized Official Name and Position | Evan Moore (FOUNDER/OWNER) |
| Authorized Official Contact | 8337493549 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthousetherapy, Llc 1777 S Harrison St Ste 1200 Denver CO 80210-3955 Ph: (833) 749-3549 | Lighthousetherapy, Llc 1777 S Harrison St Ste 1200 Denver CO 80210-3955 Ph: (833) 749-3549 |
| NPI Number | 1508593377 |
|---|---|
| Provider Enumeration Date | 08/02/2022 |
| Last Update Date | 09/15/2022 |
| Certification Date | 09/15/2022 |
| Medicare PECOS PAC ID | 6507205531 |
|---|---|
| Medicare Enrollment ID | O20240423003049 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508593377 | NPI | - | NPPES |
| Provider Name | Evan Moore |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1336757509 PECOS PAC ID: 7315386349 Enrollment ID: I20240513000870 |
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