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General NPI Number Information
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NPI Number | 1053389841
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE YOUTH SERVICES INC.
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 1071 TONG HOLLOW RD
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City | BAINBRIDGE
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State | OH
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Zip | 45612-9421
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Country | US
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Telephone | 740-634-3094
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Fax | 740-634-3047
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Provider Business Mailing Address
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Address Line | 401 E MCMILLAN ST
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City | CINCINNATI
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State | OH
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Zip | 45206-1922
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Country | US
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Telephone | 513-487-7106
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT, CFO & CAO
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Name | THUY KOLIK
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Credential |
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Telephone | 513-487-7106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | OH
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