| Doctor Name: | BRANDY R RUSSELL |
| NPI Number: | 1154644474 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PC |
| License Number: | C-0701142 |
| Business Practice Address: | 50 Greenwood Ln Springboro, OH - 450663033 |
| Business Phone Number: | 9377461154 |
| Business Fax Number: | 9377468523 |
| Mailing Address: | 204 Cook Rd, LEBANON |
| State: | OH |
| Postal Code: | 450369600 |
| Phone Number: | 5136951357 |
| Fax Number: | 5136952952 |
| NPI Enumeration Date: | 03/02/2010 |
| NPI Last Update Date: | 03/02/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | C-0701142 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |