Radiance Integrative Health & Wellness

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

RADIANCE INTEGRATIVE HEALTH & WELLNESS

Practice address

8125 SE Pine St
Portland, OR 97215-1554

Phone

(503) 743-8364

NPI assigned

Jun 29, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sundaura Lithman, LCSWNPI 1124505391

Title

Manager, Treasurer

Phone

(541) 973-3797

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lusijah Marx, PSYD, PMHNP, RN

  • Counseling Psychologist
  • Portland, OR
  • NPI 1780726976
  Medicare reassignment Care Compare group NPD
• Wendy S Neal, DO, ND

  • Neuromusculoskeletal Medicine & OMM Physician
  • Portland, OR
  • NPI 1912049172
  Medicare reassignment Care Compare group NPD
• Sundaura Lithman, MSW, CSWA

  • Mental Health Counselor
  • Portland, OR
  • NPI 1124505391
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1719619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719619200000",
    "number": "1124863261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 SW MORRISON ST STE 328",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972052214",
            "telephone_number": "503-743-8364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8125 SE PINE ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972151554",
            "telephone_number": "503-743-8364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADIANCE INTEGRATIVE HEALTH & WELLNESS",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-29",
        "last_updated": "2024-06-29",
        "certification_date": "2024-06-29",
        "status": "A",
        "authorized_official_last_name": "LITHMAN",
        "authorized_official_first_name": "SUNDAURA",
        "authorized_official_title_or_position": "MANAGER, TREASURER",
        "authorized_official_telephone_number": "541-973-3797",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Austin Radford
• Derrick Wohali Radford, MA, LPC
• Melissa Malia Radford, RN, MN, NNP-BC
• Nikole Radford, BCBA, LBA
• Latha S Radhakrishnan, MD
• Radiant Being Therapy LLC
• Radiant Mind
• Radiation Oncologists PC
• Radical Families, LLC
• Radical Healing Psychotherapy, LLC

• Health Service Clinic/Center in Portland, OR
• Providers in Portland, OR by specialty
• Health Service Clinic/Center in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.