Tamekio Russell

NPI #1538793856 in Gresham, Oregon

Provider Information

NPI Number: 1538793856
Entity Type: Individual
Name: Tamekio Russell
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Community Based Residential Treatment Facility, Mental Illness
Enumeration Date: Feb 25, 2020
Last Updated: Feb 25, 2020

Practice Location

Address: 2072 SW SANDLEWOOD PL
City: Gresham
State: Oregon
ZIP Code: 97080-9752
Phone: (503) 702-6560

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Mental Illness	320800000X	Primary

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