NPIMap

Organization Active NPI

Lighthouse Psychological Services Inc

  • Community/Behavioral Health Agency
  • Saint Paul, MN
National Provider Identifier
1548428170
Registry record updated Aug 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
LIGHTHOUSE PSYCHOLOGICAL SERVICES INC
Practice address
1551 Payne Ave
Saint Paul, MN 55130-3218
Phone
(763) 780-3077
NPI assigned
May 30, 2008
Last updated
Aug 12, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2021

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

Authorized official

Name
Mrs. Molly Pavek Olson, MANPI 1518119858
Title
Cfo
Phone
(763) 780-3307

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

1551 Payne Ave
Saint Paul, MN 55130-3218

Mailing address

1314 81St Ave NE
Spring Lake Park, MN 55432-2116

Other practice location 1

5155 E River Rd Ste 401
Fridley, MN 55421-3777
Phone (763) 780-3307

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200115000170 MN Part B Supplier - Clinic/Group Practice 3072948389 Receives reassigned benefits from 12 practitioners
1 other NPI on this enrollment
Practice locations: Faribault, MN; Fridley, MN; Saint Paul, MN

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Lighthouse Psychological Services Inc2 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.

Locations

5155 E River Rd
Ste 401
Minneapolis, MN 55421
Phone (763) 438-4038

1314 81st Ave NE
Spring Lake Park, MN 55432

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1212105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628726400000",
    "number": "1548428170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1314 81ST AVE NE",
            "city": "SPRING LAKE PARK",
            "state": "MN",
            "postal_code": "554322116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 PAYNE AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551303218",
            "telephone_number": "763-780-3077"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5155 E River Rd Ste 401",
            "address_purpose": "LOCATION",
            "city": "Fridley",
            "state": "MN",
            "postal_code": "554213777",
            "country_code": "US",
            "telephone_number": "763-780-3307",
            "fax_number": "763-780-3306",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIGHTHOUSE PSYCHOLOGICAL SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-30",
        "last_updated": "2021-08-12",
        "certification_date": "2021-08-12",
        "status": "A",
        "authorized_official_last_name": "OLSON",
        "authorized_official_first_name": "MOLLY",
        "authorized_official_middle_name": "PAVEK",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "763-780-3307",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MA"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.