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NPI Code Detail

MEDICARE: OREGON TRUAMA CENTER

MEDICARE: OREGON TRUAMA CENTER
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
1261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)C4721OR

General Provider Information

NPI Number : 1376024695
Entity Type Code : Organization
Provider Name (Legal Business Name) : OREGON TRUAMA CENTER
Provider Business Mailing Address
First Line : 10127 SW 59TH PL
Second Line :
City : PORTLAND
State : OR
Zip : 97219-5708
Country : US
Telephone Number : 503-866-9688
Fax Number :
Provider Business Practice Location Address
First Line : 5 CENTERPOINTE DR STE 400
Second Line :
City : LAKE OSWEGO
State : OR
Zip : 97035-8661
Country : US
Telephone Number : 503-866-9688
Fax Number :
Authorized Official
Title or Position : THERAPIST
Name : DR. TEREK KANSO
Credential : PSY.D. LPC
Telephone Number : 503-866-9688
Provider Enumeration Date : 08/24/2018
Last Update Date : 08/24/2018

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Directions to “OREGON TRUAMA CENTER ” Practice Location

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