Healthcare Provider Details

I. General information

NPI: 1013456177
Provider Name (Legal Business Name): GUIDING LIGHT MENTORING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2017
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6240 HAMILTON AVE STE 4
CINCINNATI OH
45224-2000
US

IV. Provider business mailing address

6240 HAMILTON AVE STE 4
CINCINNATI OH
45224-2000
US

V. Phone/Fax

Practice location:
  • Phone: 513-541-9777
  • Fax:
Mailing address:
  • Phone: 513-541-9777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateOH

VIII. Authorized Official

Name: LATISHA ALISHA OWENS
Title or Position: CEO
Credential:
Phone: 513-508-2029