| Guiding Lighthouse Therapy, Llc | |
|
2306 Nw Kings Blvd Corvallis OR 97330-3925 | |
| (541) 286-5031 | |
| Not Available |
| Full Name | Guiding Lighthouse Therapy, Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 2306 Nw Kings Blvd, Corvallis, Oregon |
| Authorized Official Name and Position | Patty Koker (MENTAL HEALTH THERAPIST) |
| Authorized Official Contact | 5412865031 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Guiding Lighthouse Therapy, Llc 2042 Sw Kendra St Corvallis OR 97333-2266 Ph: (541) 286-5031 | Guiding Lighthouse Therapy, Llc 2306 Nw Kings Blvd Corvallis OR 97330-3925 Ph: (541) 286-5031 |
| NPI Number | 1457199986 |
|---|---|
| Provider Enumeration Date | 07/18/2024 |
| Last Update Date | 07/18/2024 |
| Certification Date | 07/18/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457199986 | NPI | - | NPPES |
| 1053887109 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
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