Provider Demographics
NPI:1104129287
Name:LIGHTHOUSE COUNSELING SERVICES LLC
Entity type:Organization
Organization Name:LIGHTHOUSE COUNSELING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PRESTON
Authorized Official - Last Name:MACKINNON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:630-325-4770
Mailing Address - Street 1:244 E OGDEN AVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3648
Mailing Address - Country:US
Mailing Address - Phone:630-325-4770
Mailing Address - Fax:
Practice Address - Street 1:244 E OGDEN AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3648
Practice Address - Country:US
Practice Address - Phone:630-325-4770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000403106H00000X
IL071004301103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty