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NPI Code Detail

MEDICARE: VICTORIA ANNE LIGHTCAP MS, LMFTA

MEDICARE: VICTORIA ANNE LIGHTCAP MS, LMFTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1508013137
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICTORIA ANNE LIGHTCAP MS, LMFTA
Provider Business Mailing Address
First Line : 5618 INLAND TRL
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-5907
Country : US
Telephone Number : 260-405-8471
Fax Number :
Provider Business Practice Location Address
First Line : 3948 NEW VISION DR STE D
Second Line :
City : FORT WAYNE
State : IN
Zip : 46845-1721
Country : US
Telephone Number : 260-407-7285
Fax Number : 260-407-0094
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2008
Last Update Date : 03/12/2009

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