Healthcare Provider Details

I. General information

NPI: 1235040122
Provider Name (Legal Business Name): SHERRESA BRASFIELD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 LIBERTY ST SE STE 100
SALEM OR
97302-4165
US

IV. Provider business mailing address

7960 NW HOPE DR
CORVALLIS OR
97330-2714
US

V. Phone/Fax

Practice location:
  • Phone: 503-343-5693
  • Fax: 541-543-2238
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberR10296
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: