Individual
SHYAM ABRAHAM KOMMUKURI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7320 SW HUNZIKER RD STE 204, TIGARD, OR 97223-2301
(971) 222-8166
Mailing address
553 NW RIDGE RD, HAMMOND, OR 97121-9611
(443) 537-0938
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
C2453
OR
Other
Enumeration date
07/22/2024
Last updated
07/22/2024
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