Provider Demographics
NPI:1356136642
Name:DYNAMIC THERAPY ALLIANCE, LLC
Entity type:Organization
Organization Name:DYNAMIC THERAPY ALLIANCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:KINMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:970-258-0220
Mailing Address - Street 1:12428 NE HALSEY ST
Mailing Address - Street 2:#65
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230
Mailing Address - Country:US
Mailing Address - Phone:971-259-8022
Mailing Address - Fax:971-484-4002
Practice Address - Street 1:12428 NE HALSEY ST
Practice Address - Street 2:#65
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230
Practice Address - Country:US
Practice Address - Phone:971-259-8022
Practice Address - Fax:971-484-4002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty