Healthcare Provider Details

I. General information

NPI: 1447013743
Provider Name (Legal Business Name): LYTEHAUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 06/03/2024
Certification Date: 06/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6991 E CAMELBACK RD STE D300
SCOTTSDALE AZ
85251-2492
US

IV. Provider business mailing address

28501 SOLEIL CIR UNIT 211
BONITA SPRINGS FL
34135-6385
US

V. Phone/Fax

Practice location:
  • Phone: 949-244-8368
  • Fax:
Mailing address:
  • Phone: 239-380-9220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ALECIA M RANKOVIC
Title or Position: DR
Credential: DNP,PMHNP,APRN
Phone: 239-380-9220