Provider Demographics
NPI:1710858899
Name:EMANATE LIGHT NONPROFIT
Entity type:Organization
Organization Name:EMANATE LIGHT NONPROFIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:A
Authorized Official - Last Name:STAPLETON
Authorized Official - Suffix:
Authorized Official - Credentials:BFA
Authorized Official - Phone:801-400-0513
Mailing Address - Street 1:PO BOX 683
Mailing Address - Street 2:
Mailing Address - City:MORONI
Mailing Address - State:UT
Mailing Address - Zip Code:84646-0683
Mailing Address - Country:US
Mailing Address - Phone:801-400-0513
Mailing Address - Fax:
Practice Address - Street 1:33 N 100 E APT B7
Practice Address - Street 2:
Practice Address - City:MORONI
Practice Address - State:UT
Practice Address - Zip Code:84646-7659
Practice Address - Country:US
Practice Address - Phone:801-400-0513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-13
Last Update Date:2025-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty