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General NPI Number Information
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NPI Number | 1972019941
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Entity Type | Organization
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Legal Business Name | LIGHTHOUSE BEHAVIORAL SOLUTIONS
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Dates
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Enumeration Date | 12/28/2017
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Last Update Date | 01/05/2018
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Provider Practice Location Address
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Address Line | 18002 IRVINE BLVD. SUITE 202C
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City | TUSTIN
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State | CA
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Zip | 92780
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Country | US
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Telephone | 657-333-6085
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Fax |
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Provider Business Mailing Address
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Address Line | 18002 IRVINE BLVD. SUITE 202C
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City | TUSTIN
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State | CA
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Zip | 92780
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Country | US
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Telephone | 657-333-6085
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MRS. MANUELA O POWERS
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Credential | BCBA # 1145779
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Telephone | 949-231-7979
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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 | BCBA1145779
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License Number State |
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