NPIMap

Organization Active NPI

Lighthouse Behavioral Wellness Centers

  • Addiction Psychiatry Physician
  • Durant, OK
National Provider Identifier
1013542190
Registry record updated May 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction Psychiatry PhysicianTaxonomy code 2084P0802X
Legal business name
LIGHTHOUSE BEHAVIORAL WELLNESS CENTERS
Practice address
2425 W University Blvd
Durant, OK 74701-2970
Phone
(580) 924-7331
Fax
(580) 924-7332
NPI assigned
Mar 9, 2020
Last updated
May 20, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Deana Tharp, LPC
Title
Deputy Executive Directcor
Phone
(580) 319-7305

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction Psychiatry Physician 2084P0802X NU Primary

Addresses

Primary practice location

2425 W University Blvd
Durant, OK 74701-2970

Mailing address

2425 W University Blvd-Ste 100
Durant, OK 74701-2970

Other identifiers 1

IdentifierTypeStateIssuer
100728830MedicaidOK

National Provider Directory

National Provider Directory
Tax ID family
Mental Health Services65 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589932800000",
    "number": "1013542190",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2425 W UNIVERSITY BLVD-STE 100",
            "city": "DURANT",
            "state": "OK",
            "postal_code": "747012970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2425 W UNIVERSITY BLVD",
            "city": "DURANT",
            "state": "OK",
            "postal_code": "747012970",
            "telephone_number": "580-924-7331",
            "fax_number": "580-924-7332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE BEHAVIORAL WELLNESS CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-09",
        "last_updated": "2020-05-20",
        "certification_date": "2020-05-20",
        "status": "A",
        "authorized_official_last_name": "THARP",
        "authorized_official_first_name": "DEANA",
        "authorized_official_title_or_position": "DEPUTY EXECUTIVE DIRECTCOR",
        "authorized_official_telephone_number": "580-319-7305",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "2084P0802X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Addiction Psychiatry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100728830",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Durant, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.