Provider Demographics
NPI:1720858954
Name:KAMARA, ISSA MOHAMED
Entity type:Individual
Prefix:
First Name:ISSA
Middle Name:MOHAMED
Last Name:KAMARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 SW FRAZER AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-2800
Mailing Address - Country:US
Mailing Address - Phone:503-233-4543
Mailing Address - Fax:971-220-9883
Practice Address - Street 1:920 SW FRAZER AVE STE 102
Practice Address - Street 2:
Practice Address - City:PENDLETON
Practice Address - State:OR
Practice Address - Zip Code:97801-2800
Practice Address - Country:US
Practice Address - Phone:503-233-4543
Practice Address - Fax:971-220-9883
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health