Provider Demographics
NPI:1720204621
Name:LIGHT, STACY JOY (LPC, NBCC)
Entity Type:Individual
Prefix:MISS
First Name:STACY
Middle Name:JOY
Last Name:LIGHT
Suffix:
Gender:F
Credentials:LPC, NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11519 CRAIG CT
Mailing Address - Street 2:APT. 511
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-5283
Mailing Address - Country:US
Mailing Address - Phone:314-504-3253
Mailing Address - Fax:314-432-1996
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:STE 268A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-872-7792
Practice Address - Fax:314-251-5690
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003026702101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional