# LEAF & LOAM THERAPY LLC

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

## Provider details

- **NPI number:** 1790588846
- **Authorized official:** JOHN S MARVIN LCSW (PRACTICE MANAGER)
- **Authorized official phone:** (630) 887-6675

## Contact information

- **Practice address:** 2329 NE RODNEY AVE, PORTLAND, OR 97212-3703
- **Practice address phone:** (630) 887-6675
- **Practice address fax:** (503) 961-7266
- **Mailing address:** 2329 NE RODNEY AVE, PORTLAND, OR 97212-3703
- **Mailing address phone:** (630) 887-6675
- **Mailing address fax:** (503) 961-7266

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1041C0700X | Clinical Social Worker | — | NULL | Yes |
| 1041C0700X | Clinical Social Worker | — | — | Yes |

## Other

- **Enumeration date:** 03/31/2025
- **Last updated:** 03/31/2025