Provider Demographics
NPI:1649640582
Name:CECIL, JODY LIGHT (LPC)
Entity type:Individual
Prefix:MRS
First Name:JODY
Middle Name:LIGHT
Last Name:CECIL
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 1:7121 W BELL RD STE 115
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-8555
Mailing Address - Country:US
Mailing Address - Phone:602-908-0805
Mailing Address - Fax:
Practice Address - Street 1:7121 W BELL RD STE 115
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8555
Practice Address - Country:US
Practice Address - Phone:602-908-0805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-05
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-16981101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional