NPIMap

Organization Active NPI

Guardian Lighthouse

  • Mental Health Counselor
  • Glen Ellyn, IL
National Provider Identifier
1164793840
Registry record updated Jan 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
180005697 Issued in IL
Legal business name
GUARDIAN LIGHTHOUSE
Doing business as
Guardian Youth and Family Counseling
Practice address
460 N Main St
Suite 205
Glen Ellyn, IL 60137-5176
Phone
(847) 613-4626
NPI assigned
Jan 26, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Ryan T Porter, LCPC, CADC
Title
President/Ceo
Phone
(847) 613-4626

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 22184 IL
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X 22773 IL
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 180005697 IL Primary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X 180005201 IL

Addresses

Primary practice location

460 N Main St
Suite 205
Glen Ellyn, IL 60137-5176

Mailing address

PO Box 6181
Vernon Hills, IL 60061-6181

Other names 1

  • Guardian Youth and Family Counseling Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Guardian Lighthouse2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1327536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327536000000",
    "number": "1164793840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6181",
            "city": "VERNON HILLS",
            "state": "IL",
            "postal_code": "600616181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 N MAIN ST",
            "address_2": "SUITE 205",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601375176",
            "telephone_number": "847-613-4626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN LIGHTHOUSE",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-26",
        "last_updated": "2012-01-26",
        "status": "A",
        "authorized_official_last_name": "PORTER",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "847-613-4626",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LCPC, CADC"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "22184",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "22773",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180005697",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "IL",
            "license": "180005201",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Guardian Youth and Family Counseling",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glen Ellyn, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.