Provider Demographics
NPI:1467753061
Name:LIGHTNER, ANDREW
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:LIGHTNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3738 CAVE MILL CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-8632
Mailing Address - Country:US
Mailing Address - Phone:304-376-7607
Mailing Address - Fax:855-318-5408
Practice Address - Street 1:3738 CAVE MILL CT
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-8632
Practice Address - Country:US
Practice Address - Phone:304-376-7607
Practice Address - Fax:855-318-5408
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-12
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1-10-7831103K00000X
VA0133000030103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst