Basic Information
| Provider Information | |||||||||
| NPI: | 1528352903 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | RUSS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSW LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10011 SE DIVISION ST STE 305 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972661354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9715635690 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10011 SE DIVISION ST STE 305 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972661354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033355975 | ||||||||
| FaxNumber: | 5033355974 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2011 | ||||||||
| LastUpdateDate: | 06/20/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | L1202 | OR | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.