| Lighthouse Behavioral Wellness Centers | |
|
108 W Main St Tishomingo OK 73460-1723 | |
| (580) 371-0011 | |
| (580) 371-0206 |
| Full Name | Lighthouse Behavioral Wellness Centers |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 108 W Main St, Tishomingo, 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: () - | Lighthouse Behavioral Wellness Centers 108 W Main St Tishomingo OK 73460-1723 Ph: (580) 371-0011 |
| NPI Number | 1730462185 |
|---|---|
| Provider Enumeration Date | 09/22/2011 |
| Last Update Date | 05/20/2020 |
| Certification Date | 05/20/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730462185 | NPI | - | NPPES |
| 100728830 | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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