Provider Demographics
NPI:1316017114
Name:LIGHT, LAUREEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAUREEN
Middle Name:
Last Name:LIGHT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 3RD AVE NE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-3300
Mailing Address - Country:US
Mailing Address - Phone:425-392-5800
Mailing Address - Fax:425-313-4653
Practice Address - Street 1:310 3RD AVE NE
Practice Address - Street 2:SUITE 111
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-3300
Practice Address - Country:US
Practice Address - Phone:425-392-5800
Practice Address - Fax:425-313-4653
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 1703103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical