Healthcare Provider Details

I. General information

NPI: 1336031202
Provider Name (Legal Business Name): GUIDING LIGHT MENTAL HEALTH AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 S 100 W STE 106
LOGAN UT
84321-6067
US

IV. Provider business mailing address

911 W 2840 S
NIBLEY UT
84321-6522
US

V. Phone/Fax

Practice location:
  • Phone: 801-436-7783
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KAYCE BRADLEY
Title or Position: HEALTHCARE PROVIDER
Credential:
Phone: 801-388-3981