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1245698943
AUTUMN STARR RUSSELL
BEND, OR
NPI
1245698943
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: OR 14-12-25)
Enumeration Date
2016-02-09
Last Update Date
2016-02-09
Business Address
-- AUTUMN STARR RUSSELL CACD1
155 NE REVERE AVE
BEND, OR 97701-4147
Phone number: 541-617-4544
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Mailing Address
-- AUTUMN STARR RUSSELL CACD1
155 NE REVERE AVE
BEND, OR 97701-4147
Phone number: 541-617-4544
Copy
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