Provider Demographics
NPI:1174629281
Name:LIGHTEN, KYNTRA CHANDLER (MED)
Entity Type:Individual
Prefix:MS
First Name:KYNTRA
Middle Name:CHANDLER
Last Name:LIGHTEN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19703 EASTEX FWY STE B
Mailing Address - Street 2:BOX 56
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-3505
Mailing Address - Country:US
Mailing Address - Phone:281-570-4523
Mailing Address - Fax:281-570-4524
Practice Address - Street 1:19706 BOLTON BRIDGE LN
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-1927
Practice Address - Country:US
Practice Address - Phone:281-570-4523
Practice Address - Fax:281-570-4524
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171494103Medicaid
TX171494105Medicaid