| Organization Name: | LIGHTHOUSE CENTER FOR THERAPY & PLAY, LLC |
| NPI Number: | 1215363510 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | YVETTE MIMI RYANS (PRESIDENT/CEO) |
| Mailing Address: | 7126 Water Oak Rd Elkridge |
| State: | MD US |
| Postal Code: | 210756515 |
| Phone Number: | 2403892685 |
| Fax Number: | 4432760905 |
| NPI Enumeration Date: | 09/18/2013 |
| NPI Last Update Date: | 03/24/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |