# RADICAL REALNESS THERAPY LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639527393
- **Authorized official:** LAURA WRZESINSKI LMFT (OWNER)
- **Authorized official phone:** (971) 930-0089

## Contact information

- **Practice address:** 510 SW 3RD AVE, SUITE 200, PORTLAND, OR 97204-2543
- **Practice address phone:** (971) 930-0089
- **Mailing address:** 5131 N LINCOLN AVE STE 1, CHICAGO, IL 60625-2584
- **Mailing address phone:** (971) 930-0089

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 106H00000X | Marriage & Family Therapist | T1159 | OR | Yes |

## Other

- **Enumeration date:** 06/02/2016
- **Last updated:** 02/09/2022