Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Light Side Wellness Co

Organization Psychiatric/Mental Health Nurse Practitioner · NPI 1710660956

Light Side Wellness Co is a Psychiatric/Mental Health Nurse Practitioner in Portland, Oregon. Registered with an NPI since 2023.

In the registry since
2023

Practice location Address checks out

2175 NW Raleigh St Ste 110
Portland, OR 97210-2392
Phone: (503) 773-4673
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X

Record details

NPI number1710660956
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Steven Knott — Owner · (503) 773-4673
NPI enumeratedAugust 14, 2023
Last updated in NPPESAugust 14, 2023
Certification dateAugust 12, 2023
Mailing address2355 State St Ste 101, Salem, OR 97301-4541

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