Provider Demographics
NPI:1922639335
Name:LIGHT HOUSE CASE MANAGEMENT
Entity Type:Organization
Organization Name:LIGHT HOUSE CASE MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMPLEY FLYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-808-8554
Mailing Address - Street 1:14510 GABLE MOUNTAIN CIR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2333
Mailing Address - Country:US
Mailing Address - Phone:832-808-8554
Mailing Address - Fax:
Practice Address - Street 1:14510 GABLE MOUNTAIN CIR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2333
Practice Address - Country:US
Practice Address - Phone:832-808-8554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1083270698Medicaid