NPIMap

Organization Active NPI

Lighthouse Behavioral Wellness Centers

  • Child & Adolescent Psychiatry Physician
  • Ardmore, OK
National Provider Identifier
1649796590
Registry record updated May 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
4157 Issued in OK
Legal business name
LIGHTHOUSE BEHAVIORAL WELLNESS CENTERS
Practice address
2530 S Commerce St BLDG C
Ardmore, OK 73401-5519
Phone
(580) 226-5048
Fax
(580) 226-3569
NPI assigned
Aug 22, 2017
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, LPCNPI 1518169606
Title
Deputy Executive Director
Phone
(580) 319-7305

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician 2084P0804X 4157 OK Primary

Addresses

Primary practice location

2530 S Commerce St BLDG C
Ardmore, OK 73401-5519

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 24

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

View all 24

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1503360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589932800000",
    "number": "1649796590",
    "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": "2530 S COMMERCE ST BLDG C",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734015519",
            "telephone_number": "580-226-5048",
            "fax_number": "580-226-3569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE BEHAVIORAL WELLNESS CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-22",
        "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": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "OK",
            "license": "4157",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100728830",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ardmore, 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.