Provider Demographics
NPI:1306731617
Name:LYGHT, CRYSTAL STAR (ACLC)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:STAR
Last Name:LYGHT
Suffix:
Gender:F
Credentials:ACLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1269
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-1269
Mailing Address - Country:US
Mailing Address - Phone:406-300-8302
Mailing Address - Fax:
Practice Address - Street 1:1203 US HIGHWAY 2 W SIDE
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-6071
Practice Address - Country:US
Practice Address - Phone:406-314-6565
Practice Address - Fax:406-314-6566
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-ACLC-LIC-78912101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)