Provider Demographics
NPI:1093854747
Name:LIGHTLE, ANGELA KRISTIN (LSCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:KRISTIN
Last Name:LIGHTLE
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66101-2103
Mailing Address - Country:US
Mailing Address - Phone:913-956-4179
Mailing Address - Fax:913-956-4190
Practice Address - Street 1:1201 N 7TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66101-2103
Practice Address - Country:US
Practice Address - Phone:913-956-4179
Practice Address - Fax:913-956-4190
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5706104100000X
KS41241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100098080AMedicaid
KS3620000Medicare ID - Type Unspecified