Doctor Name: | TERESA MARIE ANTONETTE RUSSELL |
NPI Number: | 1780847616 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.C.S.W. |
License Number: | 824 |
Business Practice Address: | 29 417 E Hyw 212 Busby, MT - 590160201 |
Business Phone Number: | 4065923515 |
Business Fax Number: | |
Mailing Address: | Po Box 201, BUSBY |
State: | MT |
Postal Code: | 590160201 |
Phone Number: | 4065923515 |
Fax Number: | |
NPI Enumeration Date: | 07/10/2008 |
NPI Last Update Date: | 10/26/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 824 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |