Organization
LIGHTHOUSE BEHAVIORAL WELLNESS CENTERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEANA THARP LPC (DEPUTY EXECUTIVE DIRECTOR)
(580) 319-7305
Entity
Organization
Contact information
Practice address
2530 S COMMERCE ST BLDG C, ARDMORE, OK 73401-5519
(580) 226-5048
(580) 226-3569
Mailing address
PO BOX 189, ARDMORE, OK 73402-0189
(580) 223-5070
(580) 223-5617
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
4157
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100728830
—
OK
Enumeration date
08/22/2017
Last updated
05/20/2020
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