Organization
GUIDING LIGHT BEHAVIORAL CONSULTING
Active
Organization
GUIDING LIGHT BEHAVIORAL CONSULTING
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRYSTAL COLEMAN (OWNER)
(217) 220-1551
Entity
Organization
Contact information
Practice address
2168 OAKGLEN ST, IMPERIAL, MO 63052-4369
(217) 220-1551
Mailing address
2168 OAKGLEN ST, IMPERIAL, MO 63052-4369
(217) 220-1551
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2017039906
LBA
MO
Enumeration date
09/08/2022
Last updated
09/08/2022
Update your record
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