Healthcare Provider Details

I. General information

NPI: 1336904978
Provider Name (Legal Business Name): CHETHANA PANDIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11740 SW 68TH PKWY STE 200
TIGARD OR
97223-9058
US

IV. Provider business mailing address

13956 NW HOGAN ST
PORTLAND OR
97229-3650
US

V. Phone/Fax

Practice location:
  • Phone: 971-258-2719
  • Fax:
Mailing address:
  • Phone: 971-217-6177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberC11370
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: