| Light Mind Wellness | |
|
6734 Se Raymond St Portland OR 97206-4520 | |
| (503) 926-9567 | |
| Not Available |
| Full Name | Light Mind Wellness |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 6734 Se Raymond St, Portland, Oregon |
| Authorized Official Name and Position | Julia Perretta (OWNER/PRACTITIONER) |
| Authorized Official Contact | 5039269567 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Light Mind Wellness 5010 Se Foster Rd Portland OR 97206-3039 Ph: (503) 926-9567 | Light Mind Wellness 6734 Se Raymond St Portland OR 97206-4520 Ph: (503) 926-9567 |
| NPI Number | 1174111561 |
|---|---|
| Provider Enumeration Date | 01/01/2021 |
| Last Update Date | 02/15/2021 |
| Certification Date | 02/15/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174111561 | NPI | - | NPPES |
| 1518377167 | Other | PERSONAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
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