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Contact Information

LIGHTSPACE, INC.
1275 BIG FLAT RD
MISSOULA, MT59804-9217
 Phone: 406-728-1413
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychologist

103T00000X 62 Psychologist, Clinical
 

Professional

101YP2500X
Indicates primary specialty

NPI Profile & details for LIGHTSPACE INC · (Female)

NPI # 1497803084
Status Active
Credentials
Entity Individual
Enumeration date 01/08/2007
Last updated 09/11/2025 - About 9 months ago
Sole proprietor 1 Not specified
Identifiers
  • MT License # 960
  • UT License # 115184-2501
  • MT Medicaid 0000253164
  • MT Other 944653 LCPC, BLUE CROSS BLUE SHI
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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