Restore Therapy LLC

Primary specialty

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

License

L5795 Issued in OR

Legal business name

RESTORE THERAPY LLC

Practice address

2931 NE Broadway
Portland, OR 97232

Phone

(503) 376-7114

NPI assigned

Oct 7, 2015

Organization subpart

No

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

Authorized official

Name

Ruth Exley, LCSW

Title

Owner

Phone

(503) 376-7114

Specialties & licenses 2

Addresses

Other identifiers 3

Locations

Practitioners 3

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

• Jennifer A Dobie, MSW, LCSW

  • Clinical Social Worker
  • Portland, OR
  • NPI 1871021170
  NPD (past)
• Alyssa Mackintosh, LCSW

  • Clinical Social Worker
  • Portland, OR
  • NPI 1861860140
  NPD (past)
• Abigail Morgan Olivares, L.C.S.W.

  • Social Worker
  • Portland, OR
  • NPI 1538461470
  NPD (past)

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

{
    "created_epoch": "1444176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444176000000",
    "number": "1982075636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2931 NE BROADWAY ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972321760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2931 NE BROADWAY",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "97232",
            "telephone_number": "503-376-7114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESTORE THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-07",
        "last_updated": "2015-10-07",
        "status": "A",
        "authorized_official_last_name": "EXLEY",
        "authorized_official_first_name": "RUTH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "503-376-7114",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "L5795",
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "OR",
            "license": "L5795",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500667276",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500691922",
            "state": "OR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500672043",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Restart Counseling and Case Management, LLC
• Restoration Counseling
• Restorative Family Balance LLC
• Restorative Touch Massage
• Restorative Wellness
• Mackenzie Collen Restucci
• Retina Northwest P.C.
• Margaret Joan Retondo, MD
• Shamus Micheal Rettler
• Mark Mason Retzlaff, LMT

• Mental Health Clinic/Center (Including Community Mental Health Center) in Portland, OR
• Providers in Portland, 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 Oct 7, 2015; 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.