Provider Demographics
NPI:1033359708
Name:TESHERA, KRIS D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KRIS
Middle Name:D
Last Name:TESHERA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:KRISTIAN
Other - Middle Name:D
Other - Last Name:TESHERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9600 SW OAK ST
Mailing Address - Street 2:SUITE 280
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-6583
Mailing Address - Country:US
Mailing Address - Phone:503-521-1981
Mailing Address - Fax:503-935-5884
Practice Address - Street 1:9600 SW OAK ST
Practice Address - Street 2:SUITE 280
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-6583
Practice Address - Country:US
Practice Address - Phone:503-521-1981
Practice Address - Fax:503-935-5884
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1892103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical