| Guardian Lighthouse, Ltd | |
|
150 E Cook Ave Suite 105 Libertyville IL 60048-2060 | |
| (847) 971-3579 | |
| Not Available |
| Full Name | Guardian Lighthouse, Ltd |
|---|---|
| Speciality | Counselor - Professional |
| Location | 150 E Cook Ave, Libertyville, Illinois |
| Authorized Official Name and Position | Ryan T Porter (OWNERE) |
| Authorized Official Contact | 8479713579 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Guardian Lighthouse, Ltd 513 Deer Crossing Ct Hainesville IL 60030-3855 Ph: (847) 971-3579 | Guardian Lighthouse, Ltd 150 E Cook Ave Suite 105 Libertyville IL 60048-2060 Ph: (847) 971-3579 |
| NPI Number | 1487104667 |
|---|---|
| Provider Enumeration Date | 10/11/2016 |
| Last Update Date | 10/11/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487104667 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | 180005697 (Illinois) | Primary |
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