Provider Demographics
NPI:1982898821
Name:KEBEDE-BERHANU, KEVIN (MED, MFT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:KEBEDE-BERHANU
Suffix:
Gender:M
Credentials:MED, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 SE POWELL BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3371
Mailing Address - Country:US
Mailing Address - Phone:503-762-3207
Mailing Address - Fax:503-813-7781
Practice Address - Street 1:5416 N VANCOUVER AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-2734
Practice Address - Country:US
Practice Address - Phone:503-482-8270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2021-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist