| Lighthouse Psychological Services, Inc. | |
|
510 24th Ave Sw Norman OK 73069-5106 | |
| (405) 329-7923 | |
| (405) 329-8815 |
| Full Name | Lighthouse Psychological Services, Inc. |
|---|---|
| Speciality | Psychologist |
| Location | 510 24th Ave Sw, Norman, Oklahoma |
| Authorized Official Name and Position | Caley Gregg (LICENSED HEALTH SERVICE PSYCHOLOGIS) |
| Authorized Official Contact | 4056415367 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lighthouse Psychological Services, Inc. 510 24th Ave Sw Norman OK 73069-5106 Ph: (405) 329-7923 | Lighthouse Psychological Services, Inc. 510 24th Ave Sw Norman OK 73069-5106 Ph: (405) 329-7923 |
| NPI Number | 1639545965 |
|---|---|
| Provider Enumeration Date | 08/20/2015 |
| Last Update Date | 09/08/2015 |
| Medicare PECOS PAC ID | 2163763251 |
|---|---|
| Medicare Enrollment ID | O20190418001905 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639545965 | NPI | - | NPPES |
| 200447140 A | Medicaid | OK | |
| 200602650 A | Medicaid | OK | |
| 1639545965 | Medicaid | OK | |
| 1073891594 | Other | OK | INDIVIDUAL NPI |
| 1235499773 | Other | OK | INDIVIDUAL NPI |
| 1235499773 | Medicaid | OK | |
| 1073891594 | Medicaid | OK | |
| 200602650 B | Medicaid | OK | |
| 200599660 A | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 5124 (Oklahoma) | Secondary |
| 103T00000X | Psychologist | 1237 (Oklahoma) | Primary |
| Provider Name | Caley D Gregg |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1073891594 PECOS PAC ID: 8325309123 Enrollment ID: I20180219000127 |
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