Individual
THERESA CHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
2625 E BURNSIDE ST APT 329, PORTLAND, OR 97214-1875
(503) 852-1168
Mailing address
2625 E BURNSIDE ST APT 329, PORTLAND, OR 97214-1875
Taxonomy
Speciality
Code
Description
License number
State
103TC1900X
Counseling Psychologist
Primary
3025
OR
Other
Enumeration date
05/28/2021
Last updated
01/25/2022
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