Provider Demographics
NPI:1972019941
Name:LIGHTHOUSE BEHAVIORAL SOLUTIONS
Entity Type:Organization
Organization Name:LIGHTHOUSE BEHAVIORAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MANUELA
Authorized Official - Middle Name:O
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA # 1145779
Authorized Official - Phone:949-231-7979
Mailing Address - Street 1:18002 IRVINE BLVD.
Mailing Address - Street 2:SUITE 202C
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780
Mailing Address - Country:US
Mailing Address - Phone:657-333-6085
Mailing Address - Fax:
Practice Address - Street 1:18002 IRVINE BLVD.
Practice Address - Street 2:SUITE 202C
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:657-333-6085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-28
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BCBA1145779103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty