Healthcare Provider Details

I. General information

NPI: 1952033458
Provider Name (Legal Business Name): DAVID KREMMEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5319 SW WESTGATE DR STE 113
PORTLAND OR
97221-2432
US

IV. Provider business mailing address

5319 SW WESTGATE DR STE 113
PORTLAND OR
97221-2432
US

V. Phone/Fax

Practice location:
  • Phone: 971-254-3206
  • Fax:
Mailing address:
  • Phone: 971-254-3206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT2613
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: