Provider Demographics
NPI:1174378715
Name:LIGHTER SIDE BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:LIGHTER SIDE BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:K D
Authorized Official - Last Name:LIGHTER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:240-601-4828
Mailing Address - Street 1:4310 BALWIN DR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35805-5606
Mailing Address - Country:US
Mailing Address - Phone:240-601-4828
Mailing Address - Fax:
Practice Address - Street 1:1101 MCMURTRIE DR NW STE 4
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35806-2469
Practice Address - Country:US
Practice Address - Phone:256-719-2305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-18
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)