Provider Demographics
NPI:1316717002
Name:GUARDIAN FAMILY AND YOUTH COUNSELING
Entity type:Organization
Organization Name:GUARDIAN FAMILY AND YOUTH COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THRAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-613-2462
Mailing Address - Street 1:513 DEER CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:HAINESVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-3855
Mailing Address - Country:US
Mailing Address - Phone:847-971-3579
Mailing Address - Fax:
Practice Address - Street 1:1590 S MILWAUKEE AVE STE 201
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3797
Practice Address - Country:US
Practice Address - Phone:847-613-4626
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty