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General NPI Number Information
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NPI Number | 1841430147
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Entity Type | Organization
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Legal Business Name | RECOVERY LIGHTHOUSE
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Dates
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Enumeration Date | 02/26/2009
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Last Update Date | 11/14/2014
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Provider Practice Location Address
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Address Line | 107 E CULTON ST
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City | WARRENSBURG
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State | MO
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Zip | 64093-1823
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Country | US
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Telephone | 660-429-2222
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Fax | 660-747-6903
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Provider Business Mailing Address
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Address Line | 107 E CULTON ST
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City | WARRENSBURG
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State | MO
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Zip | 64093-1823
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Country | US
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Telephone | 660-429-2222
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Fax | 660-747-6903
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ADRIATIK LIKCANI
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Credential | LMFT, CRAADC
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Telephone | 660-441-7447
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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 | CASAC 2970
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License Number State | MO
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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 | 2009000404
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License Number State | MO
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