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General NPI Number Information
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NPI Number | 1710868443
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Entity Type | Organization
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Legal Business Name | RADICAL HEALING PSYCHOTHERAPY, LLC
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Dates
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Enumeration Date | 09/09/2025
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 5020 NE MARTIN LUTHER KING BLVD
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City | PORTLAND
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State | OR
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Zip | 97211-3204
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Country | US
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Telephone | 971-330-0612
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Fax |
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Provider Business Mailing Address
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Address Line | 15200 SW SPARROW LOOP UNIT 102
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City | BEAVERTON
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State | OR
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Zip | 97007-9358
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Country | US
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Telephone | 971-330-0612
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARILYN STEPHENS
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Credential | LCSW
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Telephone | 971-330-0612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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