NPIMap

Organization Active NPI

Lighthouse Behavioral Wellness Centers

  • Psychiatry Physician
  • Tishomingo, OK
National Provider Identifier
1154747384
Registry record updated May 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
100728830 Issued in OK
Legal business name
LIGHTHOUSE BEHAVIORAL WELLNESS CENTERS
Practice address
1000 S Byrd St
Tishomingo, OK 73460-3265
Phone
(580) 371-3019
Fax
(580) 371-0138
NPI assigned
Mar 12, 2014
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 Director
Phone
(580) 319-7305

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X 100728830 OK Primary

Addresses

Primary practice location

1000 S Byrd St
Tishomingo, OK 73460-3265

Mailing address

PO Box 189
Ardmore, OK 73402-0189
Phone (580) 223-5070

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 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1394582400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589932800000",
    "number": "1154747384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 189",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734020189",
            "telephone_number": "580-223-5070",
            "fax_number": "580-223-5617"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 S BYRD ST",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "734603265",
            "telephone_number": "580-371-3019",
            "fax_number": "580-371-0138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE BEHAVIORAL WELLNESS CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-12",
        "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 DIRECTOR",
        "authorized_official_telephone_number": "580-319-7305",
        "authorized_official_credential": "LPC"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "OK",
            "license": "100728830",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100728830",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tishomingo, 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.