Healthcare Provider Details

I. General information

NPI: 1457163776
Provider Name (Legal Business Name): KAMALA KIM TEWEE CRM, CADCR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 SW 5TH ST
PENDLETON OR
97801-2020
US

IV. Provider business mailing address

1407 NW DESPAIN AVE
PENDLETON OR
97801-1142
US

V. Phone/Fax

Practice location:
  • Phone: 541-429-4940
  • Fax: 541-429-4941
Mailing address:
  • Phone: 541-429-4940
  • Fax: 541-429-4941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number23-CRM-2512
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberT-25-4894
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: