| Lighthouse Therapy & Diagnostic Services | |
|
2509 Kolo Road Kilauea HI 96754 | |
| (808) 652-0466 | |
| Not Available |
| Full Name | Lighthouse Therapy & Diagnostic Services |
|---|---|
| Speciality | Psychologist |
| Location | 2509 Kolo Road, Kilauea, Hawaii |
| Authorized Official Name and Position | Shelly Ludolph (CLINICAL PSYCHOLOGIST) |
| Authorized Official Contact | 8086520466 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Therapy & Diagnostic Services 5108 Kuhina Pl Princeville HI 96722-5116 Ph: (808) 652-0466 | Lighthouse Therapy & Diagnostic Services 2509 Kolo Road Kilauea HI 96754 Ph: (808) 652-0466 |
| NPI Number | 1710511100 |
|---|---|
| Provider Enumeration Date | 02/25/2020 |
| Last Update Date | 02/25/2020 |
| Certification Date | 02/25/2020 |
| Medicare PECOS PAC ID | 9133559248 |
|---|---|
| Medicare Enrollment ID | O20200413002896 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710511100 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Shelly Ludolph |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1346784147 PECOS PAC ID: 0042640153 Enrollment ID: I20200413003053 |
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