| Name: | Lighthouse Psychiatry & Behavioral Health Clinic LLC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Limited Liability Company |
| Status: | Exists |
| Date of registration: | 29 Jul 2021 (3 years ago) (Companies founded in July 2021) |
| Entity Number: | 000-875-592 |
| Register Number: | 000875592 |
| ZIP code: | 36303 (Companies in Houston, 36303) |
| County: | Houston |
| Place of Formation: | Alabama |
| Registered Office Street Address: | 212 W. Troy St. STE BDothan, AL 36303 |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1730855768 | 2021-08-19 | 2022-01-31 | 8215 MADISON BLVD STE 13, MADISON, AL, 357582017, US | 8215 MADISON BLVD STE 130, MADISON, AL, 357582000, US | |||||||||||||||||||||||||||||
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| Phone | +1 256-325-2500 |
Authorized person
| Name | KATY COUSART |
| Role | CRNP |
| Phone | 2563252500 |
Taxonomy
| Taxonomy Code | 1041C0700X - Clinical Social Worker |
| Is Primary | No |
| Taxonomy Code | 363LP0808X - Psychiatric/Mental Health Nurse Practitioner |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | DORIS BELL |
| Number | 1205874856 |
| Issuer | KATY FRAZIER |
| Number | 1649710880 |
| Issuer | ANGELA WALDROP |
| Number | 1851942486 |
| Name | Role | Address |
|---|---|---|
| Registered Agents Inc | Agent | 212 W. Troy St. STE BDothan, AL 36303 |
| Name | Role | Address |
|---|---|---|
| Park, Riley | Organizer | 212 W. Troy St. STE BDothan, AL 36303 |
Date of last update: 16 Aug 2024
Sources: Alabama Secretary of State
