Provider Demographics
NPI:1558462069
Name:LIGHT, AMANDA (LMHC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:LIGHT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 W WASHINGTON STREET
Mailing Address - Street 2:SUITE 330
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-5909
Mailing Address - Country:US
Mailing Address - Phone:360-424-5141
Mailing Address - Fax:425-671-0929
Practice Address - Street 1:321 W WASHINGTON STREET
Practice Address - Street 2:SUITE 330
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-5909
Practice Address - Country:US
Practice Address - Phone:360-424-5141
Practice Address - Fax:425-671-0929
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004924101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health