Provider Demographics
NPI:1770004749
Name:RUSSELL, JULIE ANN (LMFT)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:HOFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MAIDEN NAME
Mailing Address - Street 1:11740 SW WARNER AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8459
Mailing Address - Country:US
Mailing Address - Phone:503-312-9163
Mailing Address - Fax:503-430-7207
Practice Address - Street 1:11740 SW WARNER AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-8459
Practice Address - Country:US
Practice Address - Phone:503-312-9163
Practice Address - Fax:503-430-7207
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT1088106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORT1088OtherLMFT