Doctor Name: | ADOREE ANNE RUSSELL |
NPI Number: | 1114159753 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.A., LMHC |
License Number: | T0123751 |
Business Practice Address: | 103 Goltz Dr Grants, NM - 870202155 |
Business Phone Number: | 5052853825 |
Business Fax Number: | |
Mailing Address: | 103 Goltz Dr, GRANTS |
State: | NM |
Postal Code: | 870202155 |
Phone Number: | 5052853825 |
Fax Number: | |
NPI Enumeration Date: | 08/16/2009 |
NPI Last Update Date: | 08/16/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | T0123751 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |