Russell, Jeremy K

Russell, Jeremy K is an individual health care provider with primary practice located at 410 N 9Th St , Cottage Grove OR 97424-1307. He recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as his primary health care specialty. Russell, Jeremy K can be contacted via phone (541) 942-2850.

Contact Information

Primary practice address
410 N 9Th St Cottage Grove OR 97424-1307
Phone: (541) 942-2850
Fax: (541) 942-1574
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X

Profile Details

NPI number 1396923074
LBN Legal business name Russell, Jeremy K
Credentials M.A., QMHP
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 5th, 2008
Last updated Feb 5th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1396923074 NPPES
Oregon MEDICAID 019047

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