NPIMap

Organization Active NPI

Lighthouse Behavioral Wellness Centers

  • Community/Behavioral Health Agency
  • Tishomingo, OK
National Provider Identifier
1730462185
Registry record updated May 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
LIGHTHOUSE BEHAVIORAL WELLNESS CENTERS
Practice address
108 W Main St
Tishomingo, OK 73460-1723
Phone
(580) 371-0011
Fax
(580) 371-0206
NPI assigned
Sep 22, 2011
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 Director
Phone
(580) 319-7305

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X NU Primary

Addresses

Primary practice location

108 W Main St
Tishomingo, OK 73460-1723

Mailing address

PO Box 189
Ardmore, OK 73402-0189

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

NPI Registry JSON

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

{
    "created_epoch": "1316649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589932800000",
    "number": "1730462185",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 W MAIN ST",
            "city": "TISHOMINGO",
            "state": "OK",
            "postal_code": "734601723",
            "telephone_number": "580-371-0011",
            "fax_number": "580-371-0206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHTHOUSE BEHAVIORAL WELLNESS CENTERS",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-22",
        "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": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "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.