| 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 | Psychiatry & Neurology - Psychiatry |
| 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) 223-5070 | Lighthouse Behavioral Wellness Centers 301 W 4th St Ada OK 74820-3411 Ph: (580) 436-2690 |
| NPI Number | 1386060598 |
|---|---|
| Provider Enumeration Date | 03/12/2014 |
| Last Update Date | 05/20/2020 |
| Certification Date | 05/20/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1386060598 | NPI | - | NPPES |
| 100728830 | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 100728830 (Oklahoma) | Primary |
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Lighthouse Behavioral Wellness Centers Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 301 W 4th St, Ada, OK 74820 Phone: 580-436-2690 Fax: 580-436-5539 |