Organization
GUARDIAN LIGHTHOUSE
Active
Other names
Guardian Youth and Family Counseling
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RYAN T PORTER LCPC, CADC (PRESIDENT/CEO)
(847) 613-4626
Entity
Organization
Contact information
Practice address
460 N MAIN ST, SUITE 205, GLEN ELLYN, IL 60137-5176
(847) 613-4626
Mailing address
PO BOX 6181, VERNON HILLS, IL 60061-6181
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
22184
IL
101YA0400X
Addiction (Substance Use Disorder) Counselor
22773
IL
101YM0800X
Mental Health Counselor
180005201
IL
101YM0800X
Mental Health Counselor
Primary
180005697
IL
Other
Enumeration date
01/26/2012
Last updated
01/26/2012
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