Individual provider · Type 1 NPI

Michael Russell Revell, LPC

Mental Health Counselor · Portland, OR

NPI number 1053757880 Active

Practice location

3811 SW Troy St
Portland, OR 97219-1664

Call (503) 479-8605 Map

Fax (971) 339-7047

Specialties and licenses

TaxonomyCodeLicense
Counselor 101Y00000X60961479 (WA)
Counselor 101Y00000X6991 (OR)
Counselor 101Y00000XR6261 (OR)
Counselor 101Y00000XC6991 (OR)
Mental Health Counselor 101YM0800XR6261 (OR)
Professional Counselor 101YP2500X6991 (OR)
Professional Counselor 101YP2500XC6991 (OR)
Case Manager/Care Coordinator 171M00000XNone listed
Mental Health Counselor Primary 101YM0800XC6991 (OR)

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About NPI 1053757880

Michael Russell Revell, LPC's National Provider Identifier is 1053757880, issued on May 20, 2013. The primary taxonomy on file is Mental Health Counselor (101YM0800X), and the practice location is in Portland, OR. The record was last updated on Mar 6, 2023.