| Doctor Name: | MICHELE R RUSS |
| NPI Number: | 1235388000 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MBS, LPC |
| License Number: | |
| Business Practice Address: | 1502 S Virginia Ave Atoka, OK - 745253222 |
| Business Phone Number: | 5803809097 |
| Business Fax Number: | |
| Mailing Address: | Po Box 192, ATOKA |
| State: | OK |
| Postal Code: | 745250192 |
| Phone Number: | 5803809097 |
| Fax Number: | |
| NPI Enumeration Date: | 09/16/2008 |
| NPI Last Update Date: | 05/09/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |