Healthcare Provider Details

I. General information

NPI: 1962851212
Provider Name (Legal Business Name): MIHRETU DESSALEGNE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 12/28/2025
Certification Date: 12/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 SE SUNNYSIDE RD STE 122S
CLACKAMAS OR
97015-5702
US

IV. Provider business mailing address

7320 SW HUNZIKER RD STE 204
TIGARD OR
97223-2301
US

V. Phone/Fax

Practice location:
  • Phone: 971-808-2686
  • Fax: 503-214-8732
Mailing address:
  • Phone: 971-808-2686
  • Fax: 503-214-8732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC8387
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: