Provider Demographics
NPI:1790588846
Name:LEAF & LOAM THERAPY LLC
Entity type:Organization
Organization Name:LEAF & LOAM THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARVIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-887-6675
Mailing Address - Street 1:2329 NE RODNEY AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3703
Mailing Address - Country:US
Mailing Address - Phone:630-887-6675
Mailing Address - Fax:503-961-7266
Practice Address - Street 1:2329 NE RODNEY AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3703
Practice Address - Country:US
Practice Address - Phone:630-887-6675
Practice Address - Fax:503-961-7266
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-31
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty