| Doctor Name: | DR. JIM RUSSELL |
| NPI Number: | 1275711459 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 001736 |
| Business Practice Address: | 1750 S Brentwood Blvd 559 Saint Louis, MO - 631441315 |
| Business Phone Number: | 3149638862 |
| Business Fax Number: | 3149188943 |
| Mailing Address: | 1750 S Brentwood Blvd, 559 SAINT LOUIS |
| State: | MO |
| Postal Code: | 631441315 |
| Phone Number: | 3149638862 |
| Fax Number: | 3149188943 |
| NPI Enumeration Date: | 02/10/2008 |
| NPI Last Update Date: | 02/10/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | 001736 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |