Healthcare Provider Details

I. General information

NPI: 1942555768
Provider Name (Legal Business Name): TERESA DAWN KEHRLI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39065 PIONEER BLVD STE 104
SANDY OR
97055-8088
US

IV. Provider business mailing address

39065 PIONEER BLVD STE 104
SANDY OR
97055-8088
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberC3552
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberC3552
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: