Lighthouse Psychological Services, LLC

Key facts

NPI

1356958672

Entity type

Organization (NPI type 2)

Primary specialty

Psychologist 103T00000X

Legal business name

LIGHTHOUSE PSYCHOLOGICAL SERVICES, LLC

Practice address

630 SW Nevada St
Ste. E
Poralnd, OR 97219

Phone

(541) 817-3824

Fax

(503) 389-7945

NPI assigned

Sep 30, 2020

Organization subpart

No

Authorized official

Name

Sarah Eckstein, PH.D.

Title

Owner

Phone

(541) 817-3824

National Provider Directory

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 30, 2020.

{
    "created_epoch": "1601424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601424000000",
    "number": "1356958672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2800 N LOMBARD STREET",
            "address_2": "STE. 153",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97217",
            "telephone_number": "541-817-3824",
            "fax_number": "503-389-7945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 SW NEVADA ST",
            "address_2": "STE. E",
            "city": "PORALND",
            "state": "OR",
            "postal_code": "97219",
            "telephone_number": "541-817-3824",
            "fax_number": "503-389-7945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-30",
        "last_updated": "2020-09-30",
        "certification_date": "2020-09-30",
        "status": "A",
        "authorized_official_last_name": "ECKSTEIN",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "541-817-3824",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}