Provider Demographics
NPI:1609316959
Name:LIGHTHOUSE BEHAVIORAL HEALTH, LLC
Entity type:Organization
Organization Name:LIGHTHOUSE BEHAVIORAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHAIRAS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHC, BCBA
Authorized Official - Phone:386-492-9041
Mailing Address - Street 1:533 N NOVA RD STE 112
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4420
Mailing Address - Country:US
Mailing Address - Phone:386-492-9041
Mailing Address - Fax:386-492-9061
Practice Address - Street 1:533 N NOVA RD STE 112
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4420
Practice Address - Country:US
Practice Address - Phone:386-492-9041
Practice Address - Fax:386-492-9061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104796400Medicaid
FL104313500Medicaid