SHANTEL AZURE FULLER

GRESHAM, OR
NPI1629240288
Former NameSHANTEL AZURE STONE
Entity TypeIndividual
GenderFemale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date2008-03-24
Last Update Date2008-03-24
Business Address
-- SHANTEL AZURE FULLER
400 NE 7TH ST
GRESHAM, OR 97030-5604
Phone number: 503-661-5455
Mailing Address
-- SHANTEL AZURE FULLER
10625 SE 362ND AVE UNIT C8
BORING, OR 97009-9746
Phone number: 503-313-6641
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