Provider Demographics
NPI:1609091545
Name:WALKER, RUSSELL DWAYNE (LMFT)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:DWAYNE
Last Name:WALKER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 SW YAMHILL ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2126
Mailing Address - Country:US
Mailing Address - Phone:503-679-6477
Mailing Address - Fax:
Practice Address - Street 1:1221 SW YAMHILL ST
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2126
Practice Address - Country:US
Practice Address - Phone:503-679-6477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16945101YP2500X
ORT0525106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional