Individual
MR. RICHARD SHANE MADDOX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
QMHA
Contact information
Practice address
627 NE EVANS ST, MCMINNVILLE, OR 97128-3923
(503) 434-7523
(503) 434-9846
Mailing address
445 THIRD AVE SW P.O. BOX 100, ALBANY, OR 97321-0031
(541) 967-3866
(541) 928-3020
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/17/2013
Last updated
02/06/2019
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