Provider Demographics
NPI:1043593635
Name:THE LIGHTHOUSE GUIDANCE CENTER LLC
Entity Type:Organization
Organization Name:THE LIGHTHOUSE GUIDANCE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MED, LPC
Authorized Official - Phone:405-222-8267
Mailing Address - Street 1:2204 W GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:CHICKASHA
Mailing Address - State:OK
Mailing Address - Zip Code:73018-5240
Mailing Address - Country:US
Mailing Address - Phone:405-222-8267
Mailing Address - Fax:405-222-8267
Practice Address - Street 1:2204 W. GRAND AVE
Practice Address - Street 2:
Practice Address - City:CHICKASHA
Practice Address - State:OK
Practice Address - Zip Code:73018-6405
Practice Address - Country:US
Practice Address - Phone:405-222-8267
Practice Address - Fax:405-222-8267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health