| Doctor Name: | MRS. KRISTIE ANN RUSSELL |
| NPI Number: | 1619165941 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCPC NCC |
| License Number: | |
| Business Practice Address: | 3455 Wing Hill Rd Cobden, IL - 62920 |
| Business Phone Number: | 3143305453 |
| Business Fax Number: | 6188934075 |
| Mailing Address: | 3455 Wing Hill Rd, COBDEN |
| State: | IL |
| Postal Code: | 62920 |
| Phone Number: | 3143305453 |
| Fax Number: | 6188934075 |
| NPI Enumeration Date: | 10/11/2007 |
| NPI Last Update Date: | 10/11/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |