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
108 W MAIN ST, TISHOMINGO, OK 73460-1723
(580) 371-0011
(580) 371-0206
Mailing address
PO BOX 189, ARDMORE, OK 73402-0189
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100728830
—
OK
Enumeration date
09/22/2011
Last updated
05/20/2020
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