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General NPI Number Information
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NPI Number | 1881884807
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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 | 07/26/2007
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Last Update Date | 04/18/2022
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Provider Practice Location Address
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Address Line | 2530 S COMMERCE BLDG A
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City | ARDMORE
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State | OK
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Zip | 73401-0189
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Country | US
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Telephone | 580-223-5070
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Fax | 580-223-5617
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Provider Business Mailing Address
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Address Line | PO BOX 189
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City | ARDMORE
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State | OK
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Zip | 73402-0189
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Country | US
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Telephone | 580-223-5070
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Fax | 580-223-5617
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Authorized Official
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Title or Position | EXECUTIVE ADMIN ASSISTANT
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Name | AMBER RHOTEN
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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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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