MEDICARE: MRS. JOAN COLLEEN 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	63702	TX

General Provider Information

NPI Number	:	1942597455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOAN COLLEEN RUSSELL LPC

Provider Business Mailing Address
First Line	:	1504 LEANDER RD
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78628-8801
Country	:	US
Telephone Number	:	254-624-5155
Fax Number	:

Provider Business Practice Location Address
First Line	:	3008 DAWN DR STE 101
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78628-2822
Country	:	US
Telephone Number	:	254-624-5155
Fax Number	:

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

Provider Enumeration Date	:	07/05/2011
Last Update Date	:	03/02/2026

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