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General NPI Number Information
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NPI Number | 1003441536
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Entity Type | Organization
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Legal Business Name | RESTORING BALANCE LLC
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Dates
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Enumeration Date | 03/04/2020
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Last Update Date | 08/24/2020
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Provider Practice Location Address
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Address Line | 12725 SW MILLIKAN WAY STE 300
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City | BEAVERTON
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State | OR
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Zip | 97005-1687
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Country | US
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Telephone | 503-749-9076
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Fax |
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Provider Business Mailing Address
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Address Line | 605 NW 118TH AVE UNIT 106
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City | PORTLAND
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State | OR
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Zip | 97229-6670
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Country | US
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Telephone | 503-816-9211
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | MACKENSIE MARIE KEINER
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Credential | MSW, CSWA, QMHP
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Telephone | 503-713-5040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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