MEDICARE: DR. KRIS D TESHERA PSY.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	1892	OR

General Provider Information

NPI Number	:	1033359708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRIS D TESHERA PSY.D

Provider Business Mailing Address
First Line	:	9600 SW OAK ST
Second Line	:	SUITE 280
City	:	TIGARD
State	:	OR
Zip	:	97223-6583
Country	:	US
Telephone Number	:	503-521-1981
Fax Number	:	503-935-5884

Provider Business Practice Location Address
First Line	:	9600 SW OAK ST
Second Line	:	SUITE 280
City	:	TIGARD
State	:	OR
Zip	:	97223-6583
Country	:	US
Telephone Number	:	503-521-1981
Fax Number	:	503-935-5884

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2009
Last Update Date	:	02/20/2009

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