Provider Demographics
NPI:1710601547
Name:LIGHTHOUSE MENTAL HEALTH GROUP PLLC
Entity Type:Organization
Organization Name:LIGHTHOUSE MENTAL HEALTH GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:MOHNEY
Authorized Official - Last Name:DEEVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-514-6625
Mailing Address - Street 1:4211 GARDENDALE ST STE 200A
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3529
Mailing Address - Country:US
Mailing Address - Phone:210-714-0066
Mailing Address - Fax:210-888-1449
Practice Address - Street 1:4211 GARDENDALE ST STE 200A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3529
Practice Address - Country:US
Practice Address - Phone:210-714-0066
Practice Address - Fax:210-888-1449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health