Provider Demographics
NPI:1215363510
Name:LIGHTHOUSE CENTER FOR THERAPY & PLAY
Entity Type:Organization
Organization Name:LIGHTHOUSE CENTER FOR THERAPY & PLAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:MIMI
Authorized Official - Last Name:RYANS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:443-535-3871
Mailing Address - Street 1:6925 OAKLAND MILLS ROAD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045
Mailing Address - Country:US
Mailing Address - Phone:443-864-5647
Mailing Address - Fax:443-276-0905
Practice Address - Street 1:6925 OAKLAND MILLS ROAD
Practice Address - Street 2:SUITE 206
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045
Practice Address - Country:US
Practice Address - Phone:443-864-5647
Practice Address - Fax:443-276-0905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-18
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty