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1285170795
MICHEAL DEAN AXLEY RUSS
CHICO, CA
NPI
1285170795
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2017-01-09
Last Update Date
2017-01-09
Business Address
-- MICHEAL DEAN AXLEY RUSS
590 RIO LINDO AVE
CHICO, CA 95926-1817
Phone number: 530-345-3491
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Mailing Address
-- MICHEAL DEAN AXLEY RUSS
116 INNSBROOK WAY APT 13
CHICO, CA 95973-0257
Phone number: 530-300-6354
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