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Organization
LIGHTSHINEPDX LLC
Active
Organization
LIGHTSHINEPDX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW SPRAGUE KIDDER LPC (OWNER)
(503) 358-2891
Entity
Organization
Contact information
Practice address
4531 SE BELMONT ST STE 121, PORTLAND, OR 97215-1675
(503) 358-2891
Mailing address
4531 SE BELMONT ST STE 121, PORTLAND, OR 97215-1675
(503) 358-2891
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
01/03/2024
Last updated
01/26/2024
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