MEDICARE: LIGHTHOUSE YOUTH & FAMILY THERAPY

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	106H00000X	Marriage & Family Therapist
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1871260497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIGHTHOUSE YOUTH & FAMILY THERAPY

Provider Business Mailing Address
First Line	:	PO BOX 37
Second Line	:
City	:	VERNAL
State	:	UT
Zip	:	84078-0001
Country	:	US
Telephone Number	:	435-790-2757
Fax Number	:	435-789-4045

Provider Business Practice Location Address
First Line	:	1285 W HIGHWAY 40
Second Line	:
City	:	VERNAL
State	:	UT
Zip	:	84078-2923
Country	:	US
Telephone Number	:	435-790-2757
Fax Number	:	435-789-4045

Authorized Official
Title or Position	:	OWNER
Name	:	CHARLES CRANE
Credential	:
Telephone Number	:	435-790-2757

Provider Enumeration Date	:	08/23/2021
Last Update Date	:	12/17/2025

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