Individual
TAMEKIO RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2072 SW SANDLEWOOD PL, GRESHAM, OR 97080-9752
(503) 702-6560
Mailing address
2072 SW SANDLEWOOD PL, GRESHAM, OR 97080-9752
(503) 702-6560
Taxonomy
Speciality
Code
Description
License number
State
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
02/25/2020
Last updated
02/25/2020
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