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General NPI Number Information
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NPI Number | 1316760002
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE BEHAVIORAL WELLNESS CENTER
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Dates
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Enumeration Date | 11/01/2024
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 1515 E KEARNEY ST STE 400
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City | MESQUITE
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State | TX
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Zip | 75149-2687
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Country | US
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Telephone | 214-326-2288
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Fax |
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Provider Business Mailing Address
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Address Line | 1203 ANTOINETTE DR
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City | PRINCETON
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State | TX
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Zip | 75407-2829
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Country | US
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Telephone | 214-326-2288
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. IRESHA HAYES
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Credential |
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Telephone | 214-326-2288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0006X
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Taxonomy Name | Developmental - Behavioral Pediatrics Physician
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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