Healthcare Provider Details

I. General information

NPI: 1164310447
Provider Name (Legal Business Name): GUIDING LIGHT BEHAVIORAL PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2025
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5067 N ACADEMY BLVD
COLORADO SPRINGS CO
80918-4125
US

IV. Provider business mailing address

3576 S DEPEW ST UNIT 305
LAKEWOOD CO
80235-2807
US

V. Phone/Fax

Practice location:
  • Phone: 781-742-5619
  • Fax: 719-890-7194
Mailing address:
  • Phone: 781-742-5619
  • Fax: 719-890-7194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SEAN O'BRIEN
Title or Position: CEO
Credential: BCBA
Phone: 781-742-5619