Provider Demographics
NPI:1780127142
Name:KOHRS, RUSSELL E I (CADC)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:E
Last Name:KOHRS
Suffix:I
Gender:M
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 DUNN ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-6821
Mailing Address - Country:US
Mailing Address - Phone:207-782-5187
Mailing Address - Fax:
Practice Address - Street 1:24 DUNN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-6821
Practice Address - Country:US
Practice Address - Phone:207-782-5187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC6140251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health