Healthcare Provider Details

I. General information

NPI: 1073438883
Provider Name (Legal Business Name): LIGHTHOUSE BEHAVIORAL WELLNESS CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 W MAPLE AVE STE 1
DUNCAN OK
73533-4718
US

IV. Provider business mailing address

PO BOX 189
ARDMORE OK
73402-0189
US

V. Phone/Fax

Practice location:
  • Phone: 580-319-7305
  • Fax: 580-319-7328
Mailing address:
  • Phone: 580-319-7305
  • Fax: 580-319-7328

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 State

VIII. Authorized Official

Name: DEANA MARIE THARP
Title or Position: CHIEF CLINICAL COMPLIANCE OFFICER
Credential:
Phone: 580-319-7305