Provider Demographics
NPI:1609673391
Name:LAMPLIGHT THERAPY LLC
Entity type:Organization
Organization Name:LAMPLIGHT THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANTRA
Authorized Official - Middle Name:VICTORIA
Authorized Official - Last Name:RENAULT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:541-357-8082
Mailing Address - Street 1:73560 ABEENE LN
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97424-9201
Mailing Address - Country:US
Mailing Address - Phone:541-357-8082
Mailing Address - Fax:866-931-2340
Practice Address - Street 1:20 N 5TH ST
Practice Address - Street 2:
Practice Address - City:COTTAGE GROVE
Practice Address - State:OR
Practice Address - Zip Code:97424-2005
Practice Address - Country:US
Practice Address - Phone:541-357-8082
Practice Address - Fax:866-931-2340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health