| Radiance Integrative Health & Wellness | |
|
8125 Se Pine St Portland OR 97215-1554 | |
| (503) 743-8364 | |
| Not Available |
| Full Name | Radiance Integrative Health & Wellness |
|---|---|
| Speciality | Clinic/Center |
| Location | 8125 Se Pine St, Portland, Oregon |
| Authorized Official Name and Position | Sundaura Lithman (MANAGER, TREASURER) |
| Authorized Official Contact | 5419733797 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Radiance Integrative Health & Wellness 1130 Sw Morrison St Ste 328 Portland OR 97205-2214 Ph: (503) 743-8364 | Radiance Integrative Health & Wellness 8125 Se Pine St Portland OR 97215-1554 Ph: (503) 743-8364 |
| NPI Number | 1124863261 |
|---|---|
| Provider Enumeration Date | 06/29/2024 |
| Last Update Date | 06/29/2024 |
| Certification Date | 06/29/2024 |
| Medicare PECOS PAC ID | 3870028715 |
|---|---|
| Medicare Enrollment ID | O20241202000693 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124863261 | NPI | - | NPPES |
| Provider Name | Lusijah Marx |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1780726976 PECOS PAC ID: 7517854573 Enrollment ID: I20040429000204 |
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