Provider Demographics
NPI:1639363724
Name:COMER, RUSSELL JOHN (CADC I QMHA)
Entity Type:Individual
Prefix:MR
First Name:RUSSELL
Middle Name:JOHN
Last Name:COMER
Suffix:
Gender:M
Credentials:CADC I QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 E MAIN
Mailing Address - Street 2:SUITE W
Mailing Address - City:JOHN DAY
Mailing Address - State:OR
Mailing Address - Zip Code:97845
Mailing Address - Country:US
Mailing Address - Phone:541-575-1466
Mailing Address - Fax:541-575-1411
Practice Address - Street 1:528 E MAIN
Practice Address - Street 2:SUITE W
Practice Address - City:JOHN DAY
Practice Address - State:OR
Practice Address - Zip Code:97845
Practice Address - Country:US
Practice Address - Phone:541-575-1466
Practice Address - Fax:541-575-1411
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YA0400X, 171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator