Healthcare Provider Details

I. General information

NPI: 1053246025
Provider Name (Legal Business Name): TEERIT SOMANAND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3890 SW 198TH AVE
BEAVERTON OR
97078-1270
US

IV. Provider business mailing address

3890 SW 198TH AVE
BEAVERTON OR
97078-1270
US

V. Phone/Fax

Practice location:
  • Phone: 503-926-3222
  • Fax:
Mailing address:
  • Phone: 503-926-3222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TE1100X
TaxonomyExercise & Sports Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: