LIGHTHOUSE BEHAVIORAL WELLNESS CENTERS NPI 1013542190

NPI Information

  • NPI: 1013542190
  • Provider Name: LIGHTHOUSE BEHAVIORAL WELLNESS CENTERS
  • Classification: Psychiatry & Neurology - 2084P0802X
  • Specialization: Addiction Psychiatry
  • Entity Type: Organization
  • CLIA Number: 37D2271538
  • Address: 2425 W UNIVERSITY BLVD
    DURANT, OK
    ZIP 74701
  • Phone: (580) 924-7331

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NPI Details

LIGHTHOUSE BEHAVIORAL WELLNESS CENTERS is an addiction psychiatry psychiatry neurology in Durant, OK. The provider is addiction Psychiatry is a subspecialty of psychiatry that focuses on evaluation and treatment of individuals with alcohol, drug, or other substance-related disorders, and of individuals with dual diagnosis of substance-related and other psychiatric disorders. LIGHTHOUSE BEHAVIORAL WELLNESS CENTERS NPI is 1013542190. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2425 W UNIVERSITY BLVD
DURANT, OK
ZIP 74701-970
Phone: (580) 924-7331
Fax: (580) 924-7332

The provider's authorized official is Deana Tharp .
The authorized official title is Deputy Executive Directcor and has the following contact phone number (580) 319-7305.

The CLIA number assigned to this NPI record is 37D2271538 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/9/2020 and was last updated on 5/20/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12084P0802XPsychiatry & NeurologyAddiction PsychiatryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1100728830MEDICAIDOKLAHOMA

What is NPI?

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This page was last updated on: 11/21/2025

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