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General NPI Number Information
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NPI Number | 1871260497
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE YOUTH & FAMILY THERAPY
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Dates
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Enumeration Date | 08/23/2021
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 1285 W HIGHWAY 40
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City | VERNAL
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State | UT
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Zip | 84078-2923
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Country | US
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Telephone | 435-790-2757
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Fax | 435-789-4045
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Provider Business Mailing Address
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Address Line | PO BOX 37
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City | VERNAL
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State | UT
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Zip | 84078-0001
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Country | US
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Telephone | 435-790-2757
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Fax | 435-789-4045
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES CRANE
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Credential |
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Telephone | 435-790-2757
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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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 | 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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