Provider Demographics
NPI:1962819003
Name:LIGHTHOUSE BEHAVIOR SERVICES
Entity Type:Organization
Organization Name:LIGHTHOUSE BEHAVIOR SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:LATRICE
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-484-3652
Mailing Address - Street 1:PO BOX 771822
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38177-1822
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1605 EASTMORELAND AVE
Practice Address - Street 2:1
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3849
Practice Address - Country:US
Practice Address - Phone:901-484-3652
Practice Address - Fax:866-589-5089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty