Healthcare Provider Details

I. General information

NPI: 1124978374
Provider Name (Legal Business Name): LIGHTHOUSE ABA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2026
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 EPPS ST
FORT LEONARD WOOD MO
65473-1532
US

IV. Provider business mailing address

149 EPPS ST
FORT LEONARD WOOD MO
65473-1532
US

V. Phone/Fax

Practice location:
  • Phone: 573-337-7755
  • Fax: 573-755-0992
Mailing address:
  • Phone: 573-337-7755
  • Fax: 573-755-0992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name: VICTORIA BISHOP
Title or Position: OWNER, BCBA
Credential: MA, BCBA
Phone: 573-337-7755