Provider Demographics
NPI:1447807953
Name:GUIDELIGHT MENTAL HEALTH, LLC
Entity type:Organization
Organization Name:GUIDELIGHT MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MILGRAUM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:301-980-3997
Mailing Address - Street 1:3717 DECATUR AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2148
Mailing Address - Country:US
Mailing Address - Phone:301-980-3997
Mailing Address - Fax:
Practice Address - Street 1:3717 DECATUR AVE STE 1
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2148
Practice Address - Country:US
Practice Address - Phone:301-980-3997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty