Provider Demographics
NPI:1841430147
Name:RECOVERY LIGHTHOUSE
Entity Type:Organization
Organization Name:RECOVERY LIGHTHOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIATIK
Authorized Official - Middle Name:
Authorized Official - Last Name:LIKCANI
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT, CRAADC
Authorized Official - Phone:660-441-7447
Mailing Address - Street 1:107 E CULTON ST
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-1823
Mailing Address - Country:US
Mailing Address - Phone:660-429-2222
Mailing Address - Fax:660-747-6903
Practice Address - Street 1:107 E CULTON ST
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-1823
Practice Address - Country:US
Practice Address - Phone:660-429-2222
Practice Address - Fax:660-747-6903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009000404251S00000X
MOCASAC 2970251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO=========00OtherSAM II VENDOR CODE