Individual
BRETT RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
QMHA
Contact information
Practice address
140 S HOLLY ST, MEDFORD, OR 97501-3113
(541) 774-3851
Mailing address
140 S HOLLY ST, MEDFORD, OR 97501-3113
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
NO.23-QMHA-II-000082
OR
Other
Enumeration date
07/19/2023
Last updated
07/19/2023
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