Provider Demographics
NPI:1306553896
Name:LIGHTHOUSE BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:LIGHTHOUSE BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRILANI
Authorized Official - Middle Name:
Authorized Official - Last Name:DALE
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:360-682-6167
Mailing Address - Street 1:390 NE MIDWAY BLVD STE B103
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-2645
Mailing Address - Country:US
Mailing Address - Phone:360-682-6167
Mailing Address - Fax:360-682-6176
Practice Address - Street 1:390 NE MIDWAY BLVD STE B103
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98277-2645
Practice Address - Country:US
Practice Address - Phone:360-682-6167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-03
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty