Provider Demographics
NPI:1174495626
Name:TERFASSA, TEMESGEN
Entity type:Individual
Prefix:
First Name:TEMESGEN
Middle Name:
Last Name:TERFASSA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8880 SE MANFIELD CT
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-9565
Mailing Address - Country:US
Mailing Address - Phone:503-890-5513
Mailing Address - Fax:503-206-6361
Practice Address - Street 1:8880 SE MANFIELD CT
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9565
Practice Address - Country:US
Practice Address - Phone:503-890-5513
Practice Address - Fax:503-206-6361
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health