Individual
RUSSELL EDWARD WATTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
QMHA - 1
Contact information
Practice address
2411 MARTIN LUTHER KING JR BLVD, EUGENE, OR 97401-5824
(541) 682-7625
(541) 322-7565
Mailing address
606 MEDICAL PKWY, ENTERPRISE, OR 97828-5140
(541) 426-4524
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
23-QMHA-1-004015
OR
171M00000X
Case Manager/Care Coordinator
23-QMHA-R-3380
OR
175T00000X
Peer Specialist
—
—
Other
Enumeration date
04/15/2022
Last updated
10/24/2023
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