Basic Information
| Provider Information | |||||||||
| NPI: | 1881201192 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GUIDING LIGHT MENTAL HEALTH SERVICES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 TEXAS ST STE 1050-06 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711013525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3188202022 | ||||||||
| FaxNumber: | 3187717852 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 TEXAS ST STE 1050-06 | ||||||||
| Address2: | |||||||||
| City: | SHREVEPORT | ||||||||
| State: | LA | ||||||||
| PostalCode: | 711013525 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3188202022 | ||||||||
| FaxNumber: | 3187717852 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2020 | ||||||||
| LastUpdateDate: | 04/13/2021 | ||||||||
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| AuthorizedOfficialLastName: | HICKS | ||||||||
| AuthorizedOfficialFirstName: | BRITTANY | ||||||||
| AuthorizedOfficialMiddleName: | NICOLE | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER, THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 3188202022 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | LPC | ||||||||
| NPICertificationDate: | 04/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 101YP2500X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.