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General NPI Number Information
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NPI Number | 1598186363
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE BEHAVIORAL SERVICES, LLC
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Dates
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Enumeration Date | 12/22/2013
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Last Update Date | 08/16/2024
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Provider Practice Location Address
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Address Line | 1081 3RD AVE SW STE 7
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City | CARMEL
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State | IN
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Zip | 46032-7500
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Country | US
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Telephone | 317-564-0934
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Fax | 765-807-7983
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Provider Business Mailing Address
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Address Line | 1389 W 86TH ST # 170
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-2101
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Country | US
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Telephone | 317-564-0934
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Fax | 765-807-7983
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. LYDIA ANN FOX
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Credential | MA, BCBA
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Telephone | 317-409-6151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1118239
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License Number State | IN
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