Provider Demographics
NPI:1104950229
Name:LIGHTHOUSE COUNSELING CENTER, PLC
Entity type:Organization
Organization Name:LIGHTHOUSE COUNSELING CENTER, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:870-910-3757
Mailing Address - Street 1:2912 KING ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-5321
Mailing Address - Country:US
Mailing Address - Phone:870-910-3757
Mailing Address - Fax:870-910-4999
Practice Address - Street 1:2912 KING ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-5321
Practice Address - Country:US
Practice Address - Phone:870-910-3757
Practice Address - Fax:870-910-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP9605014101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty