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General NPI Number Information
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NPI Number | 1447648811
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Entity Type | Organization
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Legal Business Name | LIGHT HOUSES BEHAVIORAL AND HABILITATION SERVICES
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Dates
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Enumeration Date | 01/07/2015
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Last Update Date | 01/07/2015
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Provider Practice Location Address
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Address Line | 7601 E TREASURE DR CU1
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City | NORTH BAY VILLAGE
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State | FL
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Zip | 33141-4391
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Country | US
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Telephone | 305-302-8022
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Fax |
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Provider Business Mailing Address
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Address Line | 7601 E TREASURE DR CU1
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City | NORTH BAY VILLAGE
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State | FL
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Zip | 33141-4391
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Country | US
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Telephone | 305-302-8022
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSELY BARRIAL
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Credential | PSYD, LMHC, BCBA-D
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Telephone | 305-302-8022
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | FL
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