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NPI Code Detail

MEDICARE: CHARLES EDWARD RUSSELL MA, LPC

MEDICARE: CHARLES EDWARD RUSSELL MA, 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
1101YM0800XMental Health CounselorLPC 4285CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841404159
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES EDWARD RUSSELL MA, LPC
Provider Business Mailing Address
First Line : 2221 A STREET RD
Second Line :
City : GREELEY
State : CO
Zip : 80631-1747
Country : US
Telephone Number : 970-566-0510
Fax Number : 970-221-2727
Provider Business Practice Location Address
First Line : 1644 S COLLEGE AVE
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-1007
Country : US
Telephone Number : 970-221-0999
Fax Number : 970-221-0999
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2007
Last Update Date : 07/08/2007

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