Phoenix Lighthouse

Primary specialty

CounselorTaxonomy code 101Y00000X

Legal business name

PHOENIX LIGHTHOUSE

Practice address

5766 Somerset Blvd
Bargersville, IN 46106

Phone

(478) 279-9802

NPI assigned

Mar 20, 2026

Organization subpart

No

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

Authorized official

Name

Kamau Sullivan, LMSW

Title

Clinical Director

Phone

(317) 409-5755

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1773964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1780963200000",
    "number": "1932057239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1710 KELLER PKWY # 2011",
            "city": "KELLER",
            "state": "TX",
            "postal_code": "762483749",
            "telephone_number": "478-279-9802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5766 SOMERSET BLVD",
            "city": "BARGERSVILLE",
            "state": "IN",
            "postal_code": "46106",
            "telephone_number": "478-279-9802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX LIGHTHOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-03-20",
        "last_updated": "2026-06-09",
        "certification_date": "2026-06-09",
        "status": "A",
        "authorized_official_last_name": "SULLIVAN",
        "authorized_official_first_name": "KAMAU",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "317-409-5755",
        "authorized_official_credential": "LMSW"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2026; 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.