Lighthouse Behavioral Health LLC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Legal business name

LIGHTHOUSE BEHAVIORAL HEALTH LLC

Practice address

6109 W Overland Rd # 101
Boise, ID 83709-3018

Phone

(208) 713-2311

NPI assigned

Apr 8, 2025

Organization subpart

No

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

Authorized official

Name

Mazin Ibraheem

Title

Owner

Phone

(208) 713-2311

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1744070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744070400000",
    "number": "1225822778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6109 W OVERLAND RD # 101",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837093018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6109 W OVERLAND RD # 101",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837093018",
            "telephone_number": "208-713-2311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE BEHAVIORAL HEALTH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-04-08",
        "last_updated": "2025-04-08",
        "certification_date": "2025-04-08",
        "status": "A",
        "authorized_official_last_name": "IBRAHEEM",
        "authorized_official_first_name": "MAZIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "208-713-2311"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2025; 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.