# LIGHT MIND WELLNESS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Light Mind Wellness
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174111561
- **Authorized official:** JULIA PERRETTA LMFT (OWNER/PRACTITIONER)
- **Authorized official phone:** (503) 926-9567

## Contact information

- **Practice address:** 6734 SE RAYMOND ST, PORTLAND, OR 97206-4520
- **Practice address phone:** (503) 926-9567
- **Mailing address:** 5010 SE FOSTER RD, PORTLAND, OR 97206-3039
- **Mailing address phone:** (503) 926-9567

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | — | NULL | Yes |
| 106H00000X | Marriage & Family Therapist | — | — | Yes |

## Other

- **Enumeration date:** 01/01/2021
- **Last updated:** 02/15/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1518377167 | PERSONAL NPI | — |