MEDICARE: LIGHTHOUSE YOUTH SERVICES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	0259	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063480846
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTHOUSE YOUTH SERVICES INC.

Provider Business Mailing Address
First Line	:	1501 MADISON RD
Second Line	:	2ND, FLOOR
City	:	CINCINNATI
State	:	OH
Zip	:	45206-1776
Country	:	US
Telephone Number	:	513-221-3350
Fax Number	:	513-221-3665

Provider Business Practice Location Address
First Line	:	131 N LUDLOW ST
Second Line	:	SUITE 384
City	:	DAYTON
State	:	OH
Zip	:	45402-1116
Country	:	US
Telephone Number	:	937-586-0435
Fax Number	:	937-586-0441

Authorized Official
Title or Position	:	VICE PRESIDENT, CFO
Name	:	MARILON WINTHER
Credential	:
Telephone Number	:	513-221-3350

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	04/07/2025

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Directions to “LIGHTHOUSE YOUTH SERVICES INC. ” Practice Location

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