Provider Demographics
NPI:1457177388
Name:LIGHTHOUSE MENTAL HEALTH SERVICES
Entity type:Organization
Organization Name:LIGHTHOUSE MENTAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIAMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-325-2500
Mailing Address - Street 1:8215 MADISON BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2034
Mailing Address - Country:US
Mailing Address - Phone:256-325-2500
Mailing Address - Fax:866-896-3657
Practice Address - Street 1:8215 MADISON BLVD STE 150
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2034
Practice Address - Country:US
Practice Address - Phone:256-325-2500
Practice Address - Fax:866-896-3657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-25
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty