Provider Demographics
NPI:1508427386
Name:LIGHT, DANIEL PAUL (LPC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:PAUL
Last Name:LIGHT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 382
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:AK
Mailing Address - Zip Code:99694-0382
Mailing Address - Country:US
Mailing Address - Phone:907-521-3240
Mailing Address - Fax:
Practice Address - Street 1:26731 W POINT MACKENZIE RD
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99623-8709
Practice Address - Country:US
Practice Address - Phone:907-376-4534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKPCOP426101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional