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NPI Code Detail

MEDICARE: THERAPY, ALTERED

MEDICARE: THERAPY, ALTERED
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101200000XDrama Therapist
2103T00000XPsychologist
31041C0700XClinical Social Worker
4106H00000XMarriage & Family Therapist
5101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1831964857
Entity Type Code : Organization
Provider Name (Legal Business Name) : THERAPY, ALTERED
Provider Business Mailing Address
First Line : 2030 SW MAIN ST
Second Line :
City : PORTLAND
State : OR
Zip : 97205-1531
Country : US
Telephone Number : 847-222-3060
Fax Number :
Provider Business Practice Location Address
First Line : 1110 SE ALDER ST STE 301
Second Line :
City : PORTLAND
State : OR
Zip : 97214-2400
Country : US
Telephone Number : 847-222-3060
Fax Number :
Authorized Official
Title or Position : OWNER
Name : REBECCA LYNN DAVIS
Credential : LCSW
Telephone Number : 847-222-3060
Provider Enumeration Date : 11/20/2023
Last Update Date : 11/20/2023

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Directions to “THERAPY, ALTERED ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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