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General NPI Number Information
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NPI Number | 1063480846
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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 | 131 N LUDLOW ST SUITE 384
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City | DAYTON
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State | OH
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Zip | 45402-1116
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Country | US
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Telephone | 937-586-0435
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Fax | 937-586-0441
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Provider Business Mailing Address
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Address Line | 1501 MADISON RD 2ND, FLOOR
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City | CINCINNATI
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State | OH
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Zip | 45206-1776
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Country | US
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Telephone | 513-221-3350
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Fax | 513-221-3665
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Authorized Official
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Title or Position | VICE PRESIDENT, CFO
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Name | MARILON WINTHER
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Credential |
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Telephone | 513-221-3350
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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 | 0259
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License Number State | OH
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