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General NPI Number Information
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NPI Number | 1275067548
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Entity Type | Organization
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Legal Business Name | GUIDING LIGHT BEHAVIORAL THERAPIES LLC
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Dates
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Enumeration Date | 04/13/2017
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Last Update Date | 04/13/2017
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Provider Practice Location Address
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Address Line | 21827 SIERRA LONG DR
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City | RICHMOND
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State | TX
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Zip | 77407-4999
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Country | US
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Telephone | 323-547-4472
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Fax |
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Provider Business Mailing Address
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Address Line | 23501 CINCO RANCH BLVD STE H120 #220
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City | KATY
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State | TX
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Zip | 77494-3095
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BEHAVIOR ANALYST
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Name | MARAI FULLER
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Credential | BCBA
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Telephone | 323-547-4472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-13-14671
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License Number State | CA
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