Organization
HEADLIGHT MENTAL HEALTHCARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW LAIRD APRN, PMHNP-BC (FOUNDER)
(541) 581-1080
Entity
Organization
Contact information
Practice address
555 SE MLK BLVD UNIT 105, PORTLAND, OR 97214-2595
(541) 581-1080
(541) 588-6525
Mailing address
555 SE MLK BLVD UNIT 105, PORTLAND, OR 97214-2595
(541) 581-1080
(541) 588-6525
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10003860
OREGON STATE BOARD OF NURSING
OR
01
—
231782392
BUSINESS REGISTRY NUMBER
OR
Enumeration date
01/07/2025
Last updated
01/07/2025
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