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General NPI Number Information
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NPI Number | 1669962536
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Entity Type | Individual
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Provider Name | TEREK KANSO PSY.D., LPC
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Gender | Male
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Dates
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Enumeration Date | 05/15/2018
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Last Update Date | 05/15/2018
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Provider Practice Location Address
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Address Line | 10127 SW 59TH PL
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City | PORTLAND
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State | OR
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Zip | 97219-5708
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Country | US
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Telephone | 503-866-9688
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Fax |
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Provider Business Mailing Address
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Address Line | 10127 SW 59TH PL
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City | PORTLAND
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State | OR
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Zip | 97219-5708
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Country | US
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Telephone | 503-866-9688
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | C4721
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License Number State | OR
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