| Lighthouse Behavioral Health, Pllc | |
|
811 Ship St Suite 4b Saint Joseph MI 49085-1171 | |
| (269) 985-3618 | |
| (269) 609-6009 |
| Full Name | Lighthouse Behavioral Health, Pllc |
|---|---|
| Speciality | Psychologist |
| Location | 811 Ship St, Saint Joseph, Michigan |
| Authorized Official Name and Position | Bruce Patrick Hackworth (OWNER/LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 2699853618 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Behavioral Health, Pllc 811 Ship St Suite 4b Saint Joseph MI 49085-1171 Ph: (269) 985-3618 | Lighthouse Behavioral Health, Pllc 811 Ship St Suite 4b Saint Joseph MI 49085-1171 Ph: (269) 985-3618 |
| NPI Number | 1699155226 |
|---|---|
| Provider Enumeration Date | 06/09/2015 |
| Last Update Date | 06/09/2015 |
| Medicare PECOS PAC ID | 7214249739 |
|---|---|
| Medicare Enrollment ID | O20150710002304 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699155226 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC1900X | Psychologist - Counseling | 6301006344 (Michigan) | Primary |
| Provider Name | Bruce P Hackworth |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1063448918 PECOS PAC ID: 2062456031 Enrollment ID: I20050610000813 |
| Provider Name | Andrew R Mahler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891134334 PECOS PAC ID: 6800299900 Enrollment ID: I20210727003519 |
| Provider Name | Gale Sandra Hackworth |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1710519376 PECOS PAC ID: 5799112827 Enrollment ID: I20220819000159 |
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