Provider Demographics
NPI:1699509448
Name:LIGHT, TEAHL (LMSW)
Entity type:Individual
Prefix:
First Name:TEAHL
Middle Name:
Last Name:LIGHT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 W 6TH ST APT D5
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-2542
Mailing Address - Country:US
Mailing Address - Phone:785-615-1779
Mailing Address - Fax:
Practice Address - Street 1:455 SE GOLF PARK BLVD STE 121
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66605-2862
Practice Address - Country:US
Practice Address - Phone:785-783-2535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMSW13692104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker