1700256591 NPI number — LIGHTHOUSE BEHAVIORAL CONSULTING

Table of content: BETHANY RUTH LOCKHART LCSW (NPI 1760753560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700256591 NPI number — LIGHTHOUSE BEHAVIORAL CONSULTING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LIGHTHOUSE BEHAVIORAL CONSULTING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700256591
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6051 SEATON DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31909-3619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-445-4905
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6051 SEATON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31909-3619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-445-4905
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/06/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MCKEE
Authorized Official First Name:
MARCUS
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
850-445-4905

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-10-6917 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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