Provider Demographics
NPI:1053759589
Name:LIGHTHOUSE ASSOCIATES LLC
Entity type:Organization
Organization Name:LIGHTHOUSE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW
Authorized Official - Phone:231-425-4414
Mailing Address - Street 1:5705 W JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-1516
Mailing Address - Country:US
Mailing Address - Phone:231-425-4414
Mailing Address - Fax:231-425-4434
Practice Address - Street 1:5705 W JOHNSON RD
Practice Address - Street 2:
Practice Address - City:LUDINGTON
Practice Address - State:MI
Practice Address - Zip Code:49431-1516
Practice Address - Country:US
Practice Address - Phone:231-425-4414
Practice Address - Fax:231-425-4434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MILB0646301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty