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General NPI Number Information
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NPI Number | 1003637851
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Entity Type | Individual
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Provider Name | KATHERINE ELLIS LIGHT PHD, PLP
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Gender | Female
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Dates
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Enumeration Date | 10/23/2024
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 3401 BERRYWOOD DR
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City | COLUMBIA
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State | MO
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Zip | 65201-8372
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Country | US
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Telephone | 573-777-8330
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Fax | 573-777-8390
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Provider Business Mailing Address
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Address Line | PO BOX 844715
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City | KANSAS CITY
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State | MO
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Zip | 64184-4715
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Country | US
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Telephone | 417-761-5214
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Fax | 417-761-5065
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2025032893
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License Number State | MO
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