Provider Demographics
NPI:1255018685
Name:THE LIGHT ABA
Entity type:Organization
Organization Name:THE LIGHT ABA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BCBA/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:KRISANNE
Authorized Official - Last Name:KYLE
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:479-466-6173
Mailing Address - Street 1:292 KELLEY PL
Mailing Address - Street 2:
Mailing Address - City:WEST FORK
Mailing Address - State:AR
Mailing Address - Zip Code:72774-3218
Mailing Address - Country:US
Mailing Address - Phone:479-466-6173
Mailing Address - Fax:
Practice Address - Street 1:292 KELLEY PL
Practice Address - Street 2:
Practice Address - City:WEST FORK
Practice Address - State:AR
Practice Address - Zip Code:72774-3218
Practice Address - Country:US
Practice Address - Phone:479-466-6173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty