OrganizationActive
Lighthouse Behavioral Wellness Centers
NPI 1649796590 · Child & Adolescent Psychiatry Physician · Ardmore, OK
Provider details
- NPI number
- 1649796590
- Entity type
- Organization
- Primary specialty
- Child & Adolescent Psychiatry PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Deana Tharp, Deputy Executive Director(580) 319-7305
- License
- 4157 (OK)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
2530 S Commerce St Bldg C
Ardmore, OK 73401-5519
Phone: (580) 226-5048
Fax: (580) 226-3569
Approximate (ZIP-level) locationGet directions
Mailing address
Po Box 189
Ardmore, OK 73402-0189
Registry dates
- Enumerated
- 2017-08-22
- Last updated
- 2020-05-20
- Certified
- 2020-05-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.