Individual
JEFFERY D LIGHTFOOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
2601 COLD SPRING RD, INDIANAPOLIS, IN 46222-2202
(317) 274-8660
Mailing address
550 N MERIDIAN ST, STE 114, INDIANAPOLIS, IN 46204-1207
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
20041870
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200487810
—
IN
Enumeration date
06/05/2006
Last updated
02/22/2010
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