Healthcare Provider Details

I. General information

NPI: 1487029583
Provider Name (Legal Business Name): FRESH PERSPECTIVES COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2015
Last Update Date: 12/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N MAIN AVE SUITE 210
GRESHAM OR
97030-7242
US

IV. Provider business mailing address

320 N MAIN AVE SUITE 210
GRESHAM OR
97030-7242
US

V. Phone/Fax

Practice location:
  • Phone: 971-400-5333
  • Fax: 503-669-6446
Mailing address:
  • Phone: 971-400-5333
  • Fax: 503-669-6446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License NumberC3552
License Number StateOR

VIII. Authorized Official

Name: MS. TERESA DAWN KEHRLI
Title or Position: CLINICAL MENTAL HEALTH COUNSELOR
Credential: LPC
Phone: 971-400-5333