| Lighthouse Behavioral Wellness Centers | |
|
301 W 4th St Ada OK 74820-3411 | |
| (580) 436-2690 | |
| (580) 436-5539 |
| Full Name | Lighthouse Behavioral Wellness Centers |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 301 W 4th St, Ada, Oklahoma |
| Authorized Official Name and Position | Deana Tharp (DEPUTY EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5803197305 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Behavioral Wellness Centers Po Box 189 Ardmore OK 73402-0189 Ph: (580) 319-7305 | Lighthouse Behavioral Wellness Centers 301 W 4th St Ada OK 74820-3411 Ph: (580) 436-2690 |
| NPI Number | 1033265764 |
|---|---|
| Provider Enumeration Date | 01/26/2007 |
| Last Update Date | 05/20/2020 |
| Certification Date | 05/20/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033265764 | NPI | - | NPPES |
| 100728830 K | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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