Provider Demographics
NPI:1447648811
Name:LIGHT HOUSES BEHAVIORAL AND HABILITATION SERVICES
Entity type:Organization
Organization Name:LIGHT HOUSES BEHAVIORAL AND HABILITATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSELY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRIAL
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LMHC, BCBA-D
Authorized Official - Phone:305-302-8022
Mailing Address - Street 1:7601 E TREASURE DR
Mailing Address - Street 2:CU1
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-4391
Mailing Address - Country:US
Mailing Address - Phone:305-302-8022
Mailing Address - Fax:
Practice Address - Street 1:7601 E TREASURE DR
Practice Address - Street 2:CU1
Practice Address - City:NORTH BAY VILLAGE
Practice Address - State:FL
Practice Address - Zip Code:33141-4391
Practice Address - Country:US
Practice Address - Phone:305-302-8022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health