NPIMap

Organization Active NPI

Radical Realness Therapy LLC

  • Marriage & Family Therapist
  • Portland, OR
National Provider Identifier
1639527393
Registry record updated Feb 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
T1159 Issued in OR
Legal business name
RADICAL REALNESS THERAPY LLC
Practice address
510 SW 3Rd Ave
Suite 200
Portland, OR 97204-2543
Phone
(971) 930-0089
NPI assigned
Jun 2, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2022

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

Authorized official

Name
Laura Wrzesinski, LMFTNPI 1861755951
Title
Owner
Phone
(971) 930-0089

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 106H00000X T1159 OR Primary

Addresses

Primary practice location

510 SW 3Rd Ave
Suite 200
Portland, OR 97204-2543

Mailing address

5131 N Lincoln Ave Ste 1
Chicago, IL 60625-2584
Phone (971) 930-0089

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1464825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644364800000",
    "number": "1639527393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5131 N LINCOLN AVE STE 1",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606252584",
            "telephone_number": "971-930-0089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 SW 3RD AVE",
            "address_2": "SUITE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972042543",
            "telephone_number": "971-930-0089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RADICAL REALNESS THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-02",
        "last_updated": "2022-02-09",
        "certification_date": "2022-02-09",
        "status": "A",
        "authorized_official_last_name": "WRZESINSKI",
        "authorized_official_first_name": "LAURA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "971-930-0089",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "OR",
            "license": "T1159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2022; 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.