Guardian Lighthouse
NPI #1164793840 in Glen Ellyn, Illinois
Provider Information
- NPI Number
- 1164793840
- Entity Type
- Organization
- Organization Name
- Guardian Lighthouse
- Primary Specialty
- Counselor - Addiction (Substance Use Disorder)
- Enumeration Date
- Jan 26, 2012
- Last Updated
- Jan 26, 2012
Practice Location
- Address
- 460 N MAIN ST
- Address 2
- SUITE 205
- City
- Glen Ellyn
- State
- Illinois
- ZIP Code
- 60137-5176
- Phone
- (847) 613-4626
Authorized Official
- Name
- MR. RYAN T PORTER, LCPC, CADC
- Title
- PRESIDENT/CEO
- Phone
- (847) 613-4626
Specialties & Taxonomy Codes
| Specialty |
|---|
| Counselor - Addiction (Substance Use Disorder) — Addiction (Substance Use Disorder) |
| Counselor - Mental Health — Mental Health |
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