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General NPI Number Information
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NPI Number | 1790588846
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Entity Type | Organization
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Legal Business Name | LEAF & LOAM THERAPY LLC
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Dates
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Enumeration Date | 03/31/2025
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Last Update Date | 03/31/2025
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Provider Practice Location Address
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Address Line | 2329 NE RODNEY AVE
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City | PORTLAND
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State | OR
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Zip | 97212-3703
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Country | US
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Telephone | 630-887-6675
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Fax | 503-961-7266
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Provider Business Mailing Address
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Address Line | 2329 NE RODNEY AVE
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City | PORTLAND
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State | OR
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Zip | 97212-3703
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Country | US
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Telephone | 630-887-6675
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Fax | 503-961-7266
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | JOHN S MARVIN
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Credential | LCSW
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Telephone | 630-887-6675
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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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