MEDICARE: GUIDING LIGHT THERAPY, LLC

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1912863135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GUIDING LIGHT THERAPY, LLC

Provider Business Mailing Address
First Line	:	1670 NE 144TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97230-4117
Country	:	US
Telephone Number	:	971-421-8660
Fax Number	:

Provider Business Practice Location Address
First Line	:	1110 SE ALDER ST STE 301
Second Line	:	#22
City	:	PORTLAND
State	:	OR
Zip	:	97214-2400
Country	:	US
Telephone Number	:	971-421-8660
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LAKEN NELSON
Credential	:	LPC
Telephone Number	:	971-421-8660

Provider Enumeration Date	:	12/31/2025
Last Update Date	:	01/12/2026

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