AUTUMN STARR RUSSELL

BEND, OR
NPI1245698943
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: OR  14-12-25)
Enumeration Date2016-02-09
Last Update Date2016-02-09
Business Address
-- AUTUMN STARR RUSSELL CACD1
155 NE REVERE AVE
BEND, OR 97701-4147
Phone number: 541-617-4544
Mailing Address
-- AUTUMN STARR RUSSELL CACD1
155 NE REVERE AVE
BEND, OR 97701-4147
Phone number: 541-617-4544
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