Provider Demographics
NPI:1295439784
Name:BEHAVIORAL LIGHTHOUSE, INC.
Entity type:Organization
Organization Name:BEHAVIORAL LIGHTHOUSE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA ALVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-725-0556
Mailing Address - Street 1:13246 SW 114TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-7916
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13246 SW 114TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-7916
Practice Address - Country:US
Practice Address - Phone:786-725-0556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty