Provider Demographics
NPI:1174117741
Name:THE LIGHTHOUSE MENTORING CENTER
Entity type:Organization
Organization Name:THE LIGHTHOUSE MENTORING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RITTER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT (52443)
Authorized Official - Phone:925-628-1641
Mailing Address - Street 1:PO BOX 853
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-0085
Mailing Address - Country:US
Mailing Address - Phone:925-267-2578
Mailing Address - Fax:
Practice Address - Street 1:325 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-2205
Practice Address - Country:US
Practice Address - Phone:925-267-2578
Practice Address - Fax:707-745-2510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-24
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness