Healthcare Provider Details

I. General information

NPI: 1598186363
Provider Name (Legal Business Name): LIGHTHOUSE BEHAVIORAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2013
Last Update Date: 08/16/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 3RD AVE SW STE 7
CARMEL IN
46032-7500
US

IV. Provider business mailing address

1389 W 86TH ST # 170
INDIANAPOLIS IN
46260-2101
US

V. Phone/Fax

Practice location:
  • Phone: 317-564-0934
  • Fax: 765-807-7983
Mailing address:
  • Phone: 317-564-0934
  • Fax: 765-807-7983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1118239
License Number StateIN

VIII. Authorized Official

Name: MRS. LYDIA ANN FOX
Title or Position: EXECUTIVE DIRECTOR
Credential: MA, BCBA
Phone: 317-409-6151