NPIMap

Organization Active NPI

Lighthouse Clinical Services LLC

  • Clinical Neuropsychologist
  • Colorado Springs, CO
National Provider Identifier
1871788349
Registry record updated Sep 7, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical NeuropsychologistTaxonomy code 103G00000X
License
2998 Issued in CO
Legal business name
LIGHTHOUSE CLINICAL SERVICES LLC
Practice address
2500 N Circle Dr
Colorado Springs, CO 80909-1184
Phone
(719) 636-3784
Fax
(719) 630-3211
NPI assigned
Sep 7, 2007
Last updated
Sep 7, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2007

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

Authorized official

Name
Dr. Bob Gant, PHD
Title
President
Phone
(719) 636-3784

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical NeuropsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103G00000X 2998 CO Primary
Clinical NeuropsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103G00000X 1788 TX

Addresses

Primary practice location

2500 N Circle Dr
Colorado Springs, CO 80909-1184

Mailing address

2500 N Circle Dr
Colorado Springs, CO 80909-1184
Phone (719) 636-3784

Other identifiers 2

IdentifierTypeStateIssuer
2998OtherCODORA
1788OtherTXSTATE BOARD OF EXAMINERS

National Provider Directory

National Provider Directory

Locations

2500 N Circle Dr
Colorado Springs, CO 80909
Phone (719) 434-8093

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1189123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189123200000",
    "number": "1871788349",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 N CIRCLE DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809091184",
            "telephone_number": "719-636-3784",
            "fax_number": "719-630-3211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N CIRCLE DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809091184",
            "telephone_number": "719-636-3784",
            "fax_number": "719-630-3211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE CLINICAL SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-07",
        "last_updated": "2007-09-07",
        "status": "A",
        "authorized_official_last_name": "GANT",
        "authorized_official_first_name": "BOB",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "719-636-3784",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "CO",
            "license": "2998",
            "primary": true
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": "TX",
            "license": "1788",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DORA",
            "identifier": "2998",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE BOARD OF EXAMINERS",
            "identifier": "1788",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2007; 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.