MEDICARE: STANLEY WAYNE 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	101Y00000X	Counselor	6401010247	MI
2	101YM0800X	Mental Health Counselor	6401010247	MI
3	101YP1600X	Pastoral Counselor	6401010247	MI
4	101YP2500X	Professional Counselor	6401010247	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	6401010247	OTHER	MI	STATE OF MICHIGAN LICENSED PROFESSIONAL COUNSELOR

General Provider Information

NPI Number	:	1366642761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STANLEY WAYNE RUSSELL LPC

Provider Business Mailing Address
First Line	:	601 S SHORE DR UNIT 224
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49014-5440
Country	:	US
Telephone Number	:	269-979-8119
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 S SHORE DR UNIT 224
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49014-5440
Country	:	US
Telephone Number	:	269-979-8119
Fax Number	:

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

Provider Enumeration Date	:	07/23/2007
Last Update Date	:	04/15/2025

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Directions to “ STANLEY WAYNE RUSSELL LPC” Practice Location

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