Doctor Name: | RUSSELL MENARD |
NPI Number: | 1376632216 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 6801084257 |
Business Practice Address: | 18th Medcom Attn: Dccs-qm (credentials) Apo, AP - 96205-0054 |
Business Phone Number: | 010-822-7916-6027 |
Business Fax Number: | 011-822-7917-8110 |
Mailing Address: | 1803 Sulky Dr Se, LACEY |
State: | WA |
Postal Code: | 985032849 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 10/11/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101Y00000X |
License Number: | 6801084257 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
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 |