| Doctor Name: | WENDY RUSSELL |
| NPI Number: | 1013362060 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | IMH11747 |
| Business Practice Address: | 405 Commercial Ct Ste E Venice, FL - 342921653 |
| Business Phone Number: | 9413754321 |
| Business Fax Number: | |
| Mailing Address: | 8461 Eagle Preserve Way, SARASOTA |
| State: | FL |
| Postal Code: | 342419449 |
| Phone Number: | 9413568340 |
| Fax Number: | |
| NPI Enumeration Date: | 04/27/2016 |
| NPI Last Update Date: | 04/27/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | IMH11747 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |