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Organization
TIFFANY KETTERMANN, LLC
Active
Organization
TIFFANY KETTERMANN, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY KETTERMANN LPC, LMHC, CADCI (CEO)
(971) 270-0167
Entity
Organization
Contact information
Practice address
2950 SE STARK ST STE 130, PORTLAND, OR 97214-3082
(971) 270-0167
Mailing address
2950 SE STARK ST STE 130, PORTLAND, OR 97214-3082
(971) 270-0167
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
08/08/2019
Last updated
02/25/2025
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