Provider Demographics
NPI:1679047765
Name:LIGHTHOUSE THERAPY, INC.
Entity Type:Organization
Organization Name:LIGHTHOUSE THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRETORS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-456-2107
Mailing Address - Street 1:701 OAK ST STE C
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:TX
Mailing Address - Zip Code:76450-3073
Mailing Address - Country:US
Mailing Address - Phone:940-549-0788
Mailing Address - Fax:
Practice Address - Street 1:701 OAK ST STE C
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:TX
Practice Address - Zip Code:76450-3073
Practice Address - Country:US
Practice Address - Phone:940-549-0788
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty