| Lighthouse Youth & Family Therapy | |
|
365 W 50 N Ste W8 Vernal UT 84078-2010 | |
| (435) 790-2757 | |
| Not Available |
| Full Name | Lighthouse Youth & Family Therapy |
|---|---|
| Speciality | Behavior Analyst |
| Location | 365 W 50 N Ste W8, Vernal, Utah |
| Authorized Official Name and Position | Charles Crane (OWNER) |
| Authorized Official Contact | 4357902757 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Youth & Family Therapy 365 W 50 N Ste W8 Vernal UT 84078-2010 Ph: (435) 790-2757 | Lighthouse Youth & Family Therapy 365 W 50 N Ste W8 Vernal UT 84078-2010 Ph: (435) 790-2757 |
| NPI Number | 1871260497 |
|---|---|
| Provider Enumeration Date | 08/23/2021 |
| Last Update Date | 03/02/2023 |
| Certification Date | 03/02/2023 |
| Medicare PECOS PAC ID | 0042604910 |
|---|---|
| Medicare Enrollment ID | O20220218002446 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1871260497 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Secondary |
| Provider Name | Diana Carney |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1962854190 PECOS PAC ID: 7416343116 Enrollment ID: I20220406000484 |
| Provider Name | Charles L Crane |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1194901637 PECOS PAC ID: 1951795822 Enrollment ID: I20240517003475 |
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