| Doctor Name: | DR. PETER ROBERT RUSSELL |
| NPI Number: | 1174540645 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH D |
| License Number: | PSY 5273 |
| Business Practice Address: | 10420 El Camino Real Atascadero, CA - 934226882 |
| Business Phone Number: | 8054665641 |
| Business Fax Number: | 8054662989 |
| Mailing Address: | 10420 El Camino Real, ATASCADERO |
| State: | CA |
| Postal Code: | 934226882 |
| Phone Number: | 8054665641 |
| Fax Number: | 8054662989 |
| NPI Enumeration Date: | 07/17/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103G00000X |
| License Number: | PSY 5273 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Clinical Neuropsychologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |