1548462054 NPI number — MRS. LESA MCANALLY LIGHTFOOT LCSW

Table of content: MRS. LESA MCANALLY LIGHTFOOT LCSW (NPI 1548462054)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548462054 NPI number — MRS. LESA MCANALLY LIGHTFOOT LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIGHTFOOT
Provider First Name:
LESA
Provider Middle Name:
MCANALLY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIGHTFOOT
Provider Other First Name:
LESA
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1548462054
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 MCKENZIE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUMMERTOWN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38483-4104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-964-4037
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24 PUBLIC SQ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCEBURG
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38464-3350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-242-6691
Provider Business Practice Location Address Fax Number:
931-762-8820
Provider Enumeration Date:
06/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LSW0000004527 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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