Individual
PHYLLIS MICHELLE BRAXTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHA
Contact information
Practice address
11261 NE KNOTT ST, PORTLAND, OR 97220-1704
(503) 253-8883
Mailing address
4025 NE 109TH AVE, PORTLAND, OR 97220-2612
(503) 891-0676
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
01/30/2007
Last updated
07/08/2007
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