Provider Demographics
NPI:1598370298
Name:LIGHTHOUSE BEHAVIORAL WELLNESS CENTERS
Entity Type:Organization
Organization Name:LIGHTHOUSE BEHAVIORAL WELLNESS CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MAUNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-319-7305
Mailing Address - Street 1:414 W MUSKOGEE AVE
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:OK
Mailing Address - Zip Code:73086-4614
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:414 W MUSKOGEE AVE
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:OK
Practice Address - Zip Code:73086-4614
Practice Address - Country:US
Practice Address - Phone:580-319-7305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIGHTHOUSE BEHAVIORAL WELLNESS CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health