Provider Demographics
NPI:1962962662
Name:J SMITH LIGHTHOUSE COUNSELING SERVICES L.L.C
Entity type:Organization
Organization Name:J SMITH LIGHTHOUSE COUNSELING SERVICES L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:727-409-6239
Mailing Address - Street 1:702 1ST CT
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3802
Mailing Address - Country:US
Mailing Address - Phone:727-409-6239
Mailing Address - Fax:727-771-0816
Practice Address - Street 1:34921 US HIGHWAY 19 N STE 310
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-1969
Practice Address - Country:US
Practice Address - Phone:727-409-6239
Practice Address - Fax:727-771-0816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-20
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)