Provider Demographics
NPI:1215699871
Name:GUIDED BY LIGHT COUNSELING, LLC
Entity type:Organization
Organization Name:GUIDED BY LIGHT COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MCKENZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:208-557-1836
Mailing Address - Street 1:4833 WILTSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202-5353
Mailing Address - Country:US
Mailing Address - Phone:208-681-5270
Mailing Address - Fax:
Practice Address - Street 1:1448 E CENTER ST STE A
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-4105
Practice Address - Country:US
Practice Address - Phone:208-557-1836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)