Healthcare Provider Details

I. General information

NPI: 1124683453
Provider Name (Legal Business Name): LIGHTHOUSE BEHAVIORAL HEALTH SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 E MAIN ST
COLUMBUS OH
43213-2950
US

IV. Provider business mailing address

4214 E MAIN ST
COLUMBUS OH
43213-3028
US

V. Phone/Fax

Practice location:
  • Phone: 614-334-6903
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: LILI C REITZ
Title or Position: CHIEF COMPLIANCE OFFICER
Credential: ESQ.
Phone: 614-334-6903