Provider Demographics
NPI:1043514425
Name:GOLIGHTLY, LISA E (L P C)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:E
Last Name:GOLIGHTLY
Suffix:
Gender:F
Credentials:L P C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 TANGLEROSE CT
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-7842
Mailing Address - Country:US
Mailing Address - Phone:972-365-5614
Mailing Address - Fax:
Practice Address - Street 1:1516 TANGLEROSE CT
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-7842
Practice Address - Country:US
Practice Address - Phone:972-365-5614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19436101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional