Provider Demographics
NPI:1700595543
Name:LIGHTHOUSE ABA AND BEHAVIORAL CONSULTING LLC
Entity Type:Organization
Organization Name:LIGHTHOUSE ABA AND BEHAVIORAL CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAKENZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCUTCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:479-427-9355
Mailing Address - Street 1:11049 RAUSCH CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:AR
Mailing Address - Zip Code:72730-2731
Mailing Address - Country:US
Mailing Address - Phone:479-437-9355
Mailing Address - Fax:
Practice Address - Street 1:11049 RAUSCH CT
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:AR
Practice Address - Zip Code:72730-2731
Practice Address - Country:US
Practice Address - Phone:479-437-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty