Basic Information
| Provider Information | |||||||||
| NPI: | 1487323911 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KEBEDE COUNSELING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9914 SE NANCY CT | ||||||||
| Address2: | |||||||||
| City: | HAPPY VALLEY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970867259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039019248 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5416 N VANCOUVER AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972172734 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034828270 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2021 | ||||||||
| LastUpdateDate: | 09/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | KEBEDE-BERHANU | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 5039019248 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LMFT | ||||||||
| NPICertificationDate: | 09/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.