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Organization
LIGHTHOUSE BEHAVIORAL WELLNESS CENTERS
Active
Organization
LIGHTHOUSE BEHAVIORAL WELLNESS CENTERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEANA THARP LPC (DEPUTY EXECUTIVE DIRECTCOR)
(580) 319-7305
Entity
Organization
Contact information
Practice address
2425 W UNIVERSITY BLVD, DURANT, OK 74701-2970
(580) 924-7331
(580) 924-7332
Mailing address
2425 W UNIVERSITY BLVD-STE 100, DURANT, OK 74701-2970
Taxonomy
Speciality
Code
Description
License number
State
2084P0802X
Addiction Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100728830
—
OK
Enumeration date
03/09/2020
Last updated
05/20/2020
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