Individual
KELLY LAURA LACOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
THW, PSS
Contact information
Practice address
261 E 12TH AVE, EUGENE, OR 97401-3208
(541) 780-4277
Mailing address
1258 HIGH ST, EUGENE, OR 97401-3238
(541) 337-1902
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
110535
OR
175T00000X
Peer Specialist
Primary
110535
OR
Other
Enumeration date
09/30/2024
Last updated
05/13/2026
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