Provider Demographics
NPI:1285757914
Name:LIGHTNER, SANDRA J
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:LIGHTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5816 CORPORATE AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-4736
Mailing Address - Country:US
Mailing Address - Phone:714-308-2958
Mailing Address - Fax:715-828-3049
Practice Address - Street 1:5816 CORPORATE AVE STE 170
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-4736
Practice Address - Country:US
Practice Address - Phone:714-308-2958
Practice Address - Fax:715-828-3049
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38988106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist