Healthcare Provider Details

I. General information

NPI: 1184543894
Provider Name (Legal Business Name): LIGHTHOUSE KIDS HIXSON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2473 LAFAYETTE RD STE 2473
FT OGLETHORPE GA
30742-3700
US

IV. Provider business mailing address

2473 LAFAYETTE RD STE 2473
FT OGLETHORPE GA
30742-3700
US

V. Phone/Fax

Practice location:
  • Phone: 423-498-9051
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE COOPER
Title or Position: REVENUE MANAGER
Credential:
Phone: 423-455-8358