Provider Demographics
NPI:1780347526
Name:LIGHTHOUSE BEHAVIORAL WELLNESS CENTERS
Entity type:Organization
Organization Name:LIGHTHOUSE BEHAVIORAL WELLNESS CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEPUTY EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:THARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-319-7305
Mailing Address - Street 1:301 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-3411
Mailing Address - Country:US
Mailing Address - Phone:580-257-2444
Mailing Address - Fax:580-257-2445
Practice Address - Street 1:301 W 4TH ST
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-3411
Practice Address - Country:US
Practice Address - Phone:580-257-2444
Practice Address - Fax:580-257-2445
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIGHTHOUSE BEHAVIORAL WELLNESS CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health