Provider Demographics
NPI:1164822193
Name:HALCYON MANAGEMENT GROUP, INC.
Entity Type:Organization
Organization Name:HALCYON MANAGEMENT GROUP, INC.
Other - Org Name:LIGHTHOUSE ADDICTION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:WYRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-255-5900
Mailing Address - Street 1:3596 TAMIAMI TRL STE 205
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8252
Mailing Address - Country:US
Mailing Address - Phone:941-255-5900
Mailing Address - Fax:941-764-8285
Practice Address - Street 1:3596 TAMIAMI TRL STE 205
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8252
Practice Address - Country:US
Practice Address - Phone:941-255-5900
Practice Address - Fax:941-764-8285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2008AD655206101YA0400X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty