MEDICARE: GUIDING LIGHT BEHAVIORAL HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1598335648
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUIDING LIGHT BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	164 BROWNS FERRY RD
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-1011
Country	:	US
Telephone Number	:	256-290-3168
Fax Number	:

Provider Business Practice Location Address
First Line	:	7738B MADISON BLVD STE 208
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35806-3661
Country	:	US
Telephone Number	:	256-290-3168
Fax Number	:

Authorized Official
Title or Position	:	OWNER/THERAPIST
Name	:	ASHLEY PHELPS
Credential	:	LICSW
Telephone Number	:	256-290-3168

Provider Enumeration Date	:	06/30/2021
Last Update Date	:	06/30/2021

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