Restoring Balance LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

RESTORING BALANCE LLC

Practice address

12725 SW Millikan Way Ste 300
Beaverton, OR 97005-1687

Phone

(503) 749-9076

NPI assigned

Mar 4, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mackensie Marie Keiner, MSW, CSWA, QMHPNPI 1497274641

Title

Psychotherapist

Phone

(503) 713-5040

Specialties & licenses 3

Addresses

Other names 1

• Restoring Balance Other name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mackensie Marie Keiner, MSW, CSWA, QMHP

  • Clinical Social Worker
  • Beaverton, OR
  • NPI 1497274641
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598227200000",
    "number": "1003441536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 NW 118TH AVE UNIT 106",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972296670",
            "telephone_number": "503-816-9211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12725 SW MILLIKAN WAY STE 300",
            "city": "BEAVERTON",
            "state": "OR",
            "postal_code": "970051687",
            "telephone_number": "503-749-9076"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORING BALANCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-04",
        "last_updated": "2020-08-24",
        "certification_date": "2020-08-24",
        "status": "A",
        "authorized_official_last_name": "KEINER",
        "authorized_official_first_name": "MACKENSIE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "503-713-5040",
        "authorized_official_credential": "MSW, CSWA, QMHP"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Restoring Balance",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Restoring Balance",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Samantha Nicole Revels
• Reverie Psychotherapy LLC
• Kathryn Rewick
• John M. Rex Jr., M.D.
• Mary Rex, MSW LCSW

• Mental Health Clinic/Center (Including Community Mental Health Center) in Beaverton, OR
• Providers in Beaverton, OR by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.