Provider Demographics
NPI:1598186363
Name:LIGHTHOUSE BEHAVIORAL SERVICES, LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE BEHAVIORAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:MA, BCBA
Authorized Official - Phone:317-409-6151
Mailing Address - Street 1:4530 AMESBURY PL
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46062-1106
Mailing Address - Country:US
Mailing Address - Phone:317-409-6151
Mailing Address - Fax:765-807-7983
Practice Address - Street 1:4530 AMESBURY PL
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46062-1106
Practice Address - Country:US
Practice Address - Phone:317-409-6151
Practice Address - Fax:765-807-7983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-22
Last Update Date:2013-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1118239103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty