Lighthouse Therapy & Diagnostic Services

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

LIGHTHOUSE THERAPY & DIAGNOSTIC SERVICES

Practice address

2509 Kolo Road
Kilauea, HI 96754

Phone

(808) 652-0466

NPI assigned

Feb 25, 2020

Last updated

Feb 25, 2020By 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

Shelly Ludolph, PSYDNPI 1346784147

Title

Clinical Psychologist

Phone

(808) 652-0466

Specialties & licenses 1

Addresses

Other names 1

• Shelly Ludolph Other name

Medicare fee-for-service enrollment

Enrolled in HI

Enrollment records 1

Locations

Practitioners 1

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.

• Shelly Ludolph, PSYD

  • Clinical Psychologist
  • Lihue, HI
  • NPI 1346784147
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1582588800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1582588800000",
    "number": "1710511100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5108 KUHINA PL",
            "city": "PRINCEVILLE",
            "state": "HI",
            "postal_code": "967225116",
            "telephone_number": "808-652-0466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2509 KOLO ROAD",
            "city": "KILAUEA",
            "state": "HI",
            "postal_code": "96754",
            "telephone_number": "808-652-0466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE THERAPY & DIAGNOSTIC SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-25",
        "last_updated": "2020-02-25",
        "certification_date": "2020-02-25",
        "status": "A",
        "authorized_official_last_name": "LUDOLPH",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "808-652-0466",
        "authorized_official_credential": "PSYD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shelly Ludolph",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Elise Kutter, LMT
• Shyonna Vivian Landrum
• Larisa Nebre, LLC
• Nicole Elizabeth Larson, LMT
• Alexander E Latif, PHARMD
• Michael Lutwin, DDS
• Asher Lyman
• Joshua Keoni McBrayer
• Melinda Menezes MD Inc
• Heather Sutherland Miller, L.AC.

• Clinical Psychologist in Kilauea, HI
• Providers in Kilauea, HI by specialty
• Clinical Psychologist in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2020; 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.