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General NPI Number Information
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NPI Number | 1457199986
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Entity Type | Organization
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Legal Business Name | GUIDING LIGHTHOUSE THERAPY, LLC
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Dates
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Enumeration Date | 07/18/2024
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Last Update Date | 07/18/2024
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Provider Practice Location Address
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Address Line | 2306 NW KINGS BLVD
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City | CORVALLIS
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State | OR
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Zip | 97330-3925
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Country | US
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Telephone | 541-286-5031
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Fax |
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Provider Business Mailing Address
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Address Line | 2042 SW KENDRA ST
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City | CORVALLIS
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State | OR
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Zip | 97333-2266
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Country | US
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Telephone | 541-286-5031
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH THERAPIST
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Name | PATTY KOKER
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Credential | LCSW
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Telephone | 541-286-5031
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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