Organization
LAMPLIGHT THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANTRA VICTORIA RENAULT LCSW (OWNER, THERAPIST)
(541) 357-8082
Entity
Organization
Contact information
Practice address
20 N 5TH ST, COTTAGE GROVE, OR 97424-2005
(541) 357-8082
(866) 931-2340
Mailing address
73560 ABEENE LN, COTTAGE GROVE, OR 97424-9201
(541) 357-8082
(866) 931-2340
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
02/28/2025
Last updated
02/28/2025
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