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General NPI Number Information
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NPI Number | 1174337885
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Entity Type | Individual
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Provider Name | COLLIN RUNGE NCC
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Gender | Male
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 128 W ANTLER AVE
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City | REDMOND
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State | OR
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Zip | 97756-1852
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Country | US
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Telephone | 541-644-4618
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Fax |
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Provider Business Mailing Address
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Address Line | 2552 NW 19TH ST
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City | REDMOND
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State | OR
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Zip | 97756-7106
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Country | US
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Telephone | 541-419-1513
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | R10527
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License Number State | OR
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