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General NPI Number Information
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NPI Number | 1780347526
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE BEHAVIORAL WELLNESS CENTERS
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Dates
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Enumeration Date | 10/19/2021
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Last Update Date | 10/19/2021
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Provider Practice Location Address
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Address Line | 301 W 4TH ST
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City | ADA
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State | OK
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Zip | 74820-3411
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Country | US
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Telephone | 580-257-2444
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Fax | 580-257-2445
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Provider Business Mailing Address
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Address Line | 301 W 4TH ST
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City | ADA
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State | OK
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Zip | 74820-3411
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Country | US
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Telephone | 580-257-2444
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Fax | 580-257-2445
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Authorized Official
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Title or Position | DEPUTY EXECUTIVE DIRECTOR
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Name | DEANA THARP
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Credential |
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Telephone | 580-319-7305
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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 |
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