Provider Demographics
NPI:1730855768
Name:LIGHTHOUSE PSYCHIATRY & BEHAVIORAL HEALTH CLINIC LLC
Entity type:Organization
Organization Name:LIGHTHOUSE PSYCHIATRY & BEHAVIORAL HEALTH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNP
Authorized Official - Prefix:
Authorized Official - First Name:KATY
Authorized Official - Middle Name:
Authorized Official - Last Name:COUSART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-325-2500
Mailing Address - Street 1:8215 MADISON BLVD STE 13
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-2017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8215 MADISON BLVD STE 130
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-2000
Practice Address - Country:US
Practice Address - Phone:256-325-2500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-19
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1205874856OtherDORIS BELL
1649710880OtherKATY FRAZIER
1851942486OtherANGELA WALDROP