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Organization
THERAPY, ALTERED
Active
Organization
THERAPY, ALTERED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA LYNN DAVIS LCSW (OWNER)
(847) 222-3060
Entity
Organization
Contact information
Practice address
1110 SE ALDER ST STE 301, PORTLAND, OR 97214-2400
(847) 222-3060
Mailing address
2030 SW MAIN ST, PORTLAND, OR 97205-1531
(847) 222-3060
Taxonomy
Speciality
Code
Description
License number
State
101200000X
Drama Therapist
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
103T00000X
Psychologist
—
—
1041C0700X
Clinical Social Worker
—
—
106H00000X
Marriage & Family Therapist
—
—
Other
Enumeration date
11/20/2023
Last updated
11/20/2023
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