Individual ProviderOwen WallulatumCounselorBehavioral Health & Social Service ProvidersPractice Address340 NW 5th St, Box 1710, Redmond, OR 97756-1869(541) 516-4087(541) 475-4822PECOS EnrollmentBased on the most recent information from CMS, provider Owen Wallulatum does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1265966055Provider TypeIndividualFull NameWallulatum, OwenCredentialCRMGenderMaleSole ProprietorNoEnumeration Date4/18/2017Last Updated4/18/2017Contact InformationPractice LocationPractice Address340 NW 5th St, Box 1710, Redmond, OR 97756-1869Phone(541) 516-4087Fax(541) 504-1195Mailing LocationMailing Address850 SW 4th St, Madras, OR 97741-9628Phone(541) 475-4822FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YA0400XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicense17 CRM 065Oregon