Provider Demographics
NPI:1336830488
Name:RUSSELL, DEBORAH CLARKE (QMHP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:CLARKE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 SE JACK AVE
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-5345
Mailing Address - Country:US
Mailing Address - Phone:541-968-7557
Mailing Address - Fax:
Practice Address - Street 1:4890 32ND AVE SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97317-9350
Practice Address - Country:US
Practice Address - Phone:503-588-5647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health