Healthcare Provider Details

I. General information

NPI: 1073387346
Provider Name (Legal Business Name): LIGHT MENTAL HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2023
Last Update Date: 09/13/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1385 LAKEVIEW AVENUE
DRACUT MA
01826-3414
US

IV. Provider business mailing address

18 SINGLEFOOT RD
CHELMSFORD MA
01824-1926
US

V. Phone/Fax

Practice location:
  • Phone: 978-545-1442
  • Fax: 978-545-1552
Mailing address:
  • Phone: 978-319-2574
  • Fax: 978-545-1552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KELLY L HARGETT
Title or Position: PMHNP-BC, OWNER
Credential: PMHNP-BC
Phone: 978-545-1442