Provider Demographics
NPI:1700256591
Name:LIGHTHOUSE BEHAVIORAL CONSULTING
Entity Type:Organization
Organization Name:LIGHTHOUSE BEHAVIORAL CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MCKEE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:850-445-4905
Mailing Address - Street 1:6051 SEATON DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-3619
Mailing Address - Country:US
Mailing Address - Phone:850-445-4905
Mailing Address - Fax:
Practice Address - Street 1:6051 SEATON DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-3619
Practice Address - Country:US
Practice Address - Phone:850-445-4905
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-10-6917103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty