{
"Npi": {
"NPI": "1083682850",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LIGHTHOUSE YOUTH SERVICES INC.",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "401 E MCMILLAN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CINCINNATI",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "45206-1922",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "513-487-7106",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "401 E MCMILLAN ST FL 2",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CINCINNATI",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "45206-1922",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "513-487-7106",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/09/2006",
"LastUpdateDate": "04/07/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KOLIK",
"AuthorizedOfficialFirstName": "THUY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "VICE PRESIDENT, CFO",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "513-487-7106",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "291U00000X",
"TaxonomyName": "Clinical Medical Laboratory",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "101YM0800X",
"TaxonomyName": "Mental Health Counselor",
"LicenseNumber": "0259",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}