Organization
LIGHT SIDE WELLNESS CO.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEVEN JON KNOTT PMHNP (OWNER)
(503) 773-4673
Entity
Organization
Contact information
Practice address
2175 NW RALEIGH ST STE 110, PORTLAND, OR 97210-2392
(503) 773-4673
Mailing address
2355 STATE ST STE 101, SALEM, OR 97301-4541
(503) 773-4673
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/14/2023
Last updated
08/14/2023
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