Provider Demographics
NPI:1811498827
Name:NICOLE LIGHTMAN, PHD
Entity type:Organization
Organization Name:NICOLE LIGHTMAN, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIGHTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-400-8171
Mailing Address - Street 1:3400 AVENUE OF THE ARTS APT A220
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-7116
Mailing Address - Country:US
Mailing Address - Phone:520-400-8171
Mailing Address - Fax:
Practice Address - Street 1:3400 AVENUE OF THE ARTS APT A220
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-7116
Practice Address - Country:US
Practice Address - Phone:520-400-8171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-25
Last Update Date:2018-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty