MEDICARE: LIGHT HOUSES BEHAVIORAL AND HABILITATION SERVICES

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	251S00000X	Community/Behavioral Health Agency		FL

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	:	1447648811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHT HOUSES BEHAVIORAL AND HABILITATION SERVICES

Provider Business Mailing Address
First Line	:	7601 E TREASURE DR
Second Line	:	CU1
City	:	NORTH BAY VILLAGE
State	:	FL
Zip	:	33141-4391
Country	:	US
Telephone Number	:	305-302-8022
Fax Number	:

Provider Business Practice Location Address
First Line	:	7601 E TREASURE DR
Second Line	:	CU1
City	:	NORTH BAY VILLAGE
State	:	FL
Zip	:	33141-4391
Country	:	US
Telephone Number	:	305-302-8022
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSELY BARRIAL
Credential	:	PSYD, LMHC, BCBA-D
Telephone Number	:	305-302-8022

Provider Enumeration Date	:	01/07/2015
Last Update Date	:	01/07/2015

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