Lighthouse Support Services LLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

LIGHTHOUSE SUPPORT SERVICES LLC

Practice address

7516 E Main St Ste 1
Mesa, AZ 85207-8332

Phone

(602) 526-0302

NPI assigned

Feb 16, 2023

Last updated

Mar 15, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jessica Evans

Title

Admin

Phone

(602) 526-0302

Specialties & licenses 5

Addresses

Other identifiers 1

Tax ID family

Lighthouse Support Services LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Lighthouse Support Services LLC

  • Substance Abuse Rehabilitation Facility
  • Mesa, AZ
  • NPI 1134875727
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1676505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710460800000",
    "number": "1033817333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7516 E MAIN ST STE 1",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852078332",
            "telephone_number": "602-526-0302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7516 E MAIN ST STE 1",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852078332",
            "telephone_number": "602-526-0302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE SUPPORT SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-16",
        "last_updated": "2024-03-15",
        "certification_date": "2023-12-15",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "ADMIN",
        "authorized_official_telephone_number": "602-526-0302"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "324500000X",
            "taxonomy_group": "",
            "desc": "Substance Abuse Rehabilitation Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "123007",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Light House Group Home LLC
• Light Touch Laser and Dental Implant Center, PLLC (Light Touch Dental Laser and Implant Center)
• Lighthouse Support Services LLC
• Daisy Hannah Liljenquist, PA
• Loren Edgar Lilly, RRT
• Christine Lillywhite, M.S., MT-BC
• Alice Lim, DDS

• Clinical Psychologist in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Clinical Psychologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.