| Organization Name: | GUARDIAN LIGHTHOUSE |
| NPI Number: | 1164793840 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RYAN T PORTER (PRESIDENT/CEO) |
| Mailing Address: | 460 N Main St Suite 205 Glen Ellyn |
| State: | IL US |
| Postal Code: | 601375176 |
| Phone Number: | 8476134626 |
| Fax Number: | |
| NPI Enumeration Date: | 01/26/2012 |
| NPI Last Update Date: | 01/26/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 22184 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |