Provider Demographics
NPI:1003441536
Name:RESTORING BALANCE LLC
Entity Type:Organization
Organization Name:RESTORING BALANCE LLC
Other - Org Name:RESTORING BALANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MACKENSIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KEINER
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, CSWA, QMHP
Authorized Official - Phone:503-713-5040
Mailing Address - Street 1:605 NW 118TH AVE UNIT 106
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-6670
Mailing Address - Country:US
Mailing Address - Phone:503-816-9211
Mailing Address - Fax:
Practice Address - Street 1:12725 SW MILLIKAN WAY STE 300
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-1687
Practice Address - Country:US
Practice Address - Phone:503-749-9076
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-04
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health