Provider Demographics
NPI:1003637851
Name:LIGHT, KATHERINE ELLIS (PHD, PLP)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:ELLIS
Last Name:LIGHT
Suffix:
Gender:F
Credentials:PHD, PLP
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ELLIS
Other - Last Name:WADLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 844715
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-4715
Mailing Address - Country:US
Mailing Address - Phone:417-761-5214
Mailing Address - Fax:417-761-5065
Practice Address - Street 1:3401 BERRYWOOD DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8372
Practice Address - Country:US
Practice Address - Phone:573-777-8330
Practice Address - Fax:573-777-8390
Is Sole Proprietor?:No
Enumeration Date:2024-10-23
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4109103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling