# FATIMA ODETALLA, NP IN PSYCHIATRY, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lighthouse Behavioral Health
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639771744
- **Authorized official:** DR. FATIMA ODETALLA DNP, APRN (OWNER)
- **Authorized official phone:** (901) 590-7680

## Contact information

- **Practice address:** 99 MAIN ST STE 302, NYACK, NY 10960-3109
- **Practice address phone:** (901) 590-7680
- **Mailing address:** 65 E MALTBIE AVE, SUFFERN, NY 10901-6007

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 11/13/2020
- **Last updated:** 11/13/2020