Provider Demographics
NPI:1811128762
Name:KAHAN, TERI MICHELLE (LCSW)
Entity type:Individual
Prefix:
First Name:TERI
Middle Name:MICHELLE
Last Name:KAHAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7080 SW FIR LOOP
Mailing Address - Street 2:SUITE #100
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8149
Mailing Address - Country:US
Mailing Address - Phone:503-661-2406
Mailing Address - Fax:
Practice Address - Street 1:7080 SW FIR LOOP
Practice Address - Street 2:SUITE #100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-8149
Practice Address - Country:US
Practice Address - Phone:503-620-1191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL40891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical