| Lighthouse Autism Center | |
|
2301 W Bradley Ave Champaign IL 61821-1849 | |
| (574) 387-4313 | |
| (574) 204-2868 |
| Full Name | Lighthouse Autism Center |
|---|---|
| Speciality | Behavior Analyst |
| Location | 2301 W Bradley Ave, Champaign, Illinois |
| Authorized Official Name and Position | Colin Sheridan (PRESIDENT) |
| Authorized Official Contact | 5743874313 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Autism Center 130 Red Coach Dr Mishawaka IN 46545-3144 Ph: (574) 387-4313 | Lighthouse Autism Center 2301 W Bradley Ave Champaign IL 61821-1849 Ph: (574) 387-4313 |
| NPI Number | 1689347999 |
|---|---|
| Provider Enumeration Date | 08/01/2021 |
| Last Update Date | 01/10/2023 |
| Certification Date | 01/10/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689347999 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103K00000X | Behavior Analyst | (* (Not Available)) | Primary |
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