Provider Demographics
NPI:1639712789
Name:LIGHT, MARGARET ATHENA (LMFT)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:ATHENA
Last Name:LIGHT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 2ND AVE SW STE 117
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MN
Mailing Address - Zip Code:55008-1500
Mailing Address - Country:US
Mailing Address - Phone:763-689-9407
Mailing Address - Fax:
Practice Address - Street 1:237 2ND AVE SW STE 117
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1500
Practice Address - Country:US
Practice Address - Phone:763-689-9407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3710106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist