Healthcare Provider Details

I. General information

NPI: 1376126466
Provider Name (Legal Business Name): CHELSEA CATHERINE ANNE LIGHTBOURN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 05/05/2021
Certification Date: 05/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S BROAD ST STE 1700
PHILADELPHIA PA
19110-1007
US

IV. Provider business mailing address

203 ROYALWOOD DR
EBENSBURG PA
15931-4336
US

V. Phone/Fax

Practice location:
  • Phone: 215-701-1560
  • Fax:
Mailing address:
  • Phone: 814-410-7223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: