Individual
ALEX BLAINE RISSEEUW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2507 CHRISTIE DRIVE, LAKE OSWEGO, OR 97034
(503) 635-3416
Mailing address
PO BOX 230278, PORTLAND, OR 97281-0278
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
06/22/2022
Last updated
06/22/2022
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