Provider Demographics
NPI:1982461935
Name:RUSSELL, ALAINA
Entity type:Individual
Prefix:
First Name:ALAINA
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 SW BAIRD ST APT 4
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-6026
Mailing Address - Country:US
Mailing Address - Phone:541-297-6404
Mailing Address - Fax:
Practice Address - Street 1:704 W HOOD AVE STE D
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-1529
Practice Address - Country:US
Practice Address - Phone:541-640-9310
Practice Address - Fax:360-326-1978
Is Sole Proprietor?:No
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health