Provider Demographics
NPI:1396187324
Name:THE LIGHTHOUSE GROUP
Entity Type:Organization
Organization Name:THE LIGHTHOUSE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:M
Authorized Official - Last Name:REDIX
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:903-276-0530
Mailing Address - Street 1:303 JAMISTON ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-1842
Mailing Address - Country:US
Mailing Address - Phone:903-244-3018
Mailing Address - Fax:
Practice Address - Street 1:303 JAMISTON ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-1842
Practice Address - Country:US
Practice Address - Phone:903-244-3018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-18
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management