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General NPI Number Information
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NPI Number | 1184510489
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Entity Type | Organization
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Legal Business Name | GUARDIAN WAY LLC
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 615 N 18TH ST STE 106
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City | LAFAYETTE
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State | IN
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Zip | 47904-3413
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Country | US
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Telephone | 765-205-8002
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Fax |
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Provider Business Mailing Address
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Address Line | 615 N 18TH ST SUITE 106
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City | LAFAYETTE
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State | IN
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Zip | 47904-3413
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Country | US
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Telephone | 765-205-8002
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | CLIFFORD BERNARD NORMAN JR.
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Credential | MS, NCC, LMHC
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Telephone | 727-768-9176
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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