Provider Demographics
NPI:1679184337
Name:LIGHT, JOY (LMFT)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
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 1:10235 FAIR OAKS BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7166
Mailing Address - Country:US
Mailing Address - Phone:916-426-2757
Mailing Address - Fax:916-200-1536
Practice Address - Street 1:300 HARDING BLVD STE 211
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-2473
Practice Address - Country:US
Practice Address - Phone:916-426-2757
Practice Address - Fax:916-200-1536
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT113423106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist