Provider Demographics
NPI:1821857459
Name:RAVDIN-TENG, KEIDI YUNTING
Entity Type:Individual
Prefix:
First Name:KEIDI
Middle Name:YUNTING
Last Name:RAVDIN-TENG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3748 N MISSOURI AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1171
Mailing Address - Country:US
Mailing Address - Phone:310-663-2720
Mailing Address - Fax:
Practice Address - Street 1:1942 NW KEARNEY ST STE 11
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-1463
Practice Address - Country:US
Practice Address - Phone:971-254-1357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health