| Lighthouse Therapy & Assessment Services Pllc | |
|
2401 Judson Rd Ste 102 Longview TX 75605-4636 | |
| (469) 334-3615 | |
| Not Available |
| Full Name | Lighthouse Therapy & Assessment Services Pllc |
|---|---|
| Speciality | Counselor |
| Location | 2401 Judson Rd Ste 102, Longview, Texas |
| Authorized Official Name and Position | Taylor Parker (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 9037361028 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Therapy & Assessment Services Pllc 2401 Judson Rd Ste 102 Longview TX 75605-4636 Ph: (469) 334-3615 | Lighthouse Therapy & Assessment Services Pllc 2401 Judson Rd Ste 102 Longview TX 75605-4636 Ph: (469) 334-3615 |
| NPI Number | 1174334023 |
|---|---|
| Provider Enumeration Date | 01/17/2025 |
| Last Update Date | 06/11/2025 |
| Certification Date | 06/11/2025 |
| Medicare PECOS PAC ID | 0042736381 |
|---|---|
| Medicare Enrollment ID | O20250429002767 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174334023 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Taylor Parker |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1669138772 PECOS PAC ID: 4688026446 Enrollment ID: I20240117001420 |
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