Light Side Wellness Co.

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

Legal business name

LIGHT SIDE WELLNESS CO.

Practice address

2175 NW Raleigh St Ste 110
Portland, OR 97210-2392

Phone

(503) 773-4673

NPI assigned

Aug 14, 2023

Last updated

Aug 14, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Steven Jon Knott, PMHNPNPI 1093315236

Title

Owner

Phone

(503) 773-4673

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Steven Jon Knott, APRN, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Boise, ID
  • NPI 1093315236

  OR

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1691971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691971200000",
    "number": "1710660956",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2355 STATE ST STE 101",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973014541",
            "telephone_number": "503-773-4673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2175 NW RALEIGH ST STE 110",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102392",
            "telephone_number": "503-773-4673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIGHT SIDE WELLNESS CO.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-14",
        "last_updated": "2023-08-14",
        "certification_date": "2023-08-12",
        "status": "A",
        "authorized_official_last_name": "KNOTT",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "JON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-773-4673",
        "authorized_official_credential": "PMHNP"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lifeworks Northwest
• Lifeworks Northwest
• Lifeworks Northwest
• Lifeworks NW
• Light Mind Wellness
• Light Within Therapy LLC
• Gretchen Elizabeth Light, MA
• Jacob D Light, M.D.
• Lindi Jo Fawn Light, QMHA
• Michael L Lightfoot

• Psychiatric/Mental Health Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2023; 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.