Healthcare Provider Details

I. General information

NPI: 1942742044
Provider Name (Legal Business Name): TAUNYA MARIE GESNER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAUNYA MARIE HEDBOR

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 SE STARK ST STE 202
GRESHAM OR
97030-8328
US

IV. Provider business mailing address

25500 SE STARK ST STE 202
GRESHAM OR
97030-8328
US

V. Phone/Fax

Practice location:
  • Phone: 503-504-4622
  • Fax:
Mailing address:
  • Phone: 503-504-4622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR5821
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC6765
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: