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Organization
RESTORE THERAPY LLC
Active
Organization
RESTORE THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RUTH EXLEY LCSW (OWNER)
(503) 376-7114
Entity
Organization
Contact information
Practice address
2931 NE BROADWAY, PORTLAND, OR 97232
(503) 376-7114
Mailing address
2931 NE BROADWAY ST, PORTLAND, OR 97232-1760
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
L5795
OR
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
L5795
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500667276
—
OR
05
—
500672043
—
OR
05
—
500691922
—
OR
Enumeration date
10/07/2015
Last updated
10/07/2015
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