Provider Demographics
NPI:1508984394
Name:LIGHT, LINDA BAIRD (LPC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:BAIRD
Last Name:LIGHT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 AVALON RD
Mailing Address - Street 2:
Mailing Address - City:STAR CITY
Mailing Address - State:AR
Mailing Address - Zip Code:71667-8979
Mailing Address - Country:US
Mailing Address - Phone:870-370-1468
Mailing Address - Fax:
Practice Address - Street 1:1371 HIGHWAY 278 W
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-9663
Practice Address - Country:US
Practice Address - Phone:870-367-2141
Practice Address - Fax:870-367-2103
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0002004101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor