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General NPI Number Information
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NPI Number | 1487090403
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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 | 05/16/2013
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Last Update Date | 05/16/2013
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Provider Practice Location Address
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Address Line | 4259 WALTON AVE
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City | LOS ANGELES
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State | CA
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Zip | 90037-2427
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Country | US
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Telephone | 424-209-9032
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Fax |
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Provider Business Mailing Address
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Address Line | 4259 WALTON AVE
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City | LOS ANGELES
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State | CA
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Zip | 90037-2427
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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 | CEO
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Name | MARAI FULLER
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Credential |
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Telephone | 424-209-9032
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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 | 1-11-8356
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License Number State | CA
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