Provider Demographics
NPI:1083682850
Name:LIGHTHOUSE YOUTH SERVICES INC.
Entity Type:Organization
Organization Name:LIGHTHOUSE YOUTH SERVICES INC.
Other - Org Name:LIGHTHOUSE YOUTH & FAMILY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:THUY
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-487-7106
Mailing Address - Street 1:401 E MCMILLAN ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1922
Mailing Address - Country:US
Mailing Address - Phone:513-487-7106
Mailing Address - Fax:
Practice Address - Street 1:401 E MCMILLAN ST FL 2
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1922
Practice Address - Country:US
Practice Address - Phone:513-487-7106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0259101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH10128Medicaid