Provider Demographics
NPI:1871287482
Name:TESNER, PHILLIP BRANDON (CADC-R)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:BRANDON
Last Name:TESNER
Suffix:
Gender:M
Credentials:CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 E BURNSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1751
Mailing Address - Country:US
Mailing Address - Phone:503-729-5236
Mailing Address - Fax:
Practice Address - Street 1:1535 N WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1885
Practice Address - Country:US
Practice Address - Phone:503-238-2067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)