Healthcare Provider Details

I. General information

NPI: 1063480846
Provider Name (Legal Business Name): LIGHTHOUSE YOUTH SERVICES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 N LUDLOW ST SUITE 384
DAYTON OH
45402-1116
US

IV. Provider business mailing address

1501 MADISON RD 2ND, FLOOR
CINCINNATI OH
45206-1776
US

V. Phone/Fax

Practice location:
  • Phone: 937-586-0435
  • Fax: 937-586-0441
Mailing address:
  • Phone: 513-221-3350
  • Fax: 513-221-3665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0259
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: MARILON WINTHER
Title or Position: VICE PRESIDENT, CFO
Credential:
Phone: 513-221-3350