Provider Demographics
NPI:1922351766
Name:BRISBIN, TERESA SUZANNE (MA MFT)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:SUZANNE
Last Name:BRISBIN
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 SE 9TH ST
Mailing Address - Street 2:
Mailing Address - City:DUNDEE
Mailing Address - State:OR
Mailing Address - Zip Code:97115-9635
Mailing Address - Country:US
Mailing Address - Phone:503-476-2934
Mailing Address - Fax:
Practice Address - Street 1:18650 SW BOONES FERRY RD
Practice Address - Street 2:SUITE 3
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-8491
Practice Address - Country:US
Practice Address - Phone:502-476-2934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR2697101YP2500X
ORR2698106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional