Provider Demographics
NPI:1871998484
Name:LIGHTBODY, JEANNE (BCBA)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:LIGHTBODY
Suffix:
Gender:F
Credentials:BCBA
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 160771
Mailing Address - Street 2:3170 TWO MOONS RD.
Mailing Address - City:BIG SKY
Mailing Address - State:MT
Mailing Address - Zip Code:59716-0771
Mailing Address - Country:US
Mailing Address - Phone:914-391-9972
Mailing Address - Fax:
Practice Address - Street 1:3170 TWO MOONS ROAD
Practice Address - Street 2:
Practice Address - City:BIG SKY
Practice Address - State:MT
Practice Address - Zip Code:59716-0771
Practice Address - Country:US
Practice Address - Phone:914-391-9972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst