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
2010 BOREN BLVD, SEMINOLE, OK 74868-2050
(580) 223-5070
(580) 223-5617
Mailing address
PO BOX 189, ARDMORE, OK 73402-0189
(580) 223-5070
(580) 223-5617
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100728830 L
—
OK
Enumeration date
01/26/2007
Last updated
05/20/2020
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