Healthcare Provider Details

I. General information

NPI: 1720858954
Provider Name (Legal Business Name): ISSA MOHAMED KAMARA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2024
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 SW FRAZER AVE STE 102
PENDLETON OR
97801-2800
US

IV. Provider business mailing address

920 SW FRAZER AVE STE 102
PENDLETON OR
97801-2800
US

V. Phone/Fax

Practice location:
  • Phone: 503-233-4543
  • Fax: 971-220-9883
Mailing address:
  • Phone: 503-233-4543
  • Fax: 971-220-9883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: