Blake Jeffrey Russell
Blake Jeffrey Russell is a Behavior Technician in Oceanside, California. Practices as a sole proprietor. Registered with an NPI since 2022.
- In the registry since
- 2022
Practice location Address checks out
3784 Mission Ave Ste 148-1085Oceanside, CA 92058-1460
Phone: (540) 383-7133
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Specialties & licences
| Behavior Technician (primary) | Taxonomy 106S00000X |
|---|
Record details
| NPI number | 1568197077 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | Yes |
| NPI enumerated | July 19, 2022 |
| Last updated in NPPES | July 19, 2022 |
| Certification date | July 19, 2022 |
| Mailing address | 3784 Mission Ave Ste 148-1085, Oceanside, CA 92058-1460 |
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