Provider Demographics
NPI:1992560148
Name:LIBERATION THERAPY CENTER LLC
Entity type:Organization
Organization Name:LIBERATION THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KNUTSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:503-744-7269
Mailing Address - Street 1:4531 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-2644
Mailing Address - Country:US
Mailing Address - Phone:630-251-4458
Mailing Address - Fax:
Practice Address - Street 1:1110 SE ALDER ST STE 301
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-2400
Practice Address - Country:US
Practice Address - Phone:503-744-7269
Practice Address - Fax:503-506-6974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical