Provider Demographics
NPI:1073008520
Name:LIGHT, MARCIA R
Entity type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:R
Last Name:LIGHT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 S 1125 W
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5230
Mailing Address - Country:US
Mailing Address - Phone:801-663-1006
Mailing Address - Fax:
Practice Address - Street 1:375 N MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1278
Practice Address - Country:US
Practice Address - Phone:801-872-4230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2025-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1073008520OtherBCBS, U OF U, EMI