Individual
BRUCE LIGHT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
301 CHESTNUT ST, MOUNT SHASTA, CA 96067-2214
(530) 926-1436
(530) 926-2305
Mailing address
301 CHESTNUT ST, MOUNT SHASTA, CA 96067-2214
(530) 926-1436
(530) 926-2305
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
03/09/2017
Last updated
03/09/2017
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