MEDICARE: MRS. JENNIFER LEIGH RUSSELL LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	84683	TX

General Provider Information

NPI Number	:	1144940867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER LEIGH RUSSELL LPC

Provider Business Mailing Address
First Line	:	2132 BENT TRL
Second Line	:
City	:	KAUFMAN
State	:	TX
Zip	:	75142-5381
Country	:	US
Telephone Number	:	469-474-9077
Fax Number	:

Provider Business Practice Location Address
First Line	:	506 WASHINGTON STREET
Second Line	:
City	:	KAUFMAN
State	:	TX
Zip	:	75142
Country	:	US
Telephone Number	:	972-932-8898
Fax Number	:	972-932-8890

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2022
Last Update Date	:	06/12/2026

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