Provider Demographics
NPI:1639042807
Name:LIGHTNER, JAMIE E
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:E
Last Name:LIGHTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11224 CAMM RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGPORT
Mailing Address - State:MI
Mailing Address - Zip Code:49284-9429
Mailing Address - Country:US
Mailing Address - Phone:517-242-0224
Mailing Address - Fax:
Practice Address - Street 1:2017 4TH ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-4572
Practice Address - Country:US
Practice Address - Phone:517-581-4886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-24
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011209571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty