Healthcare Provider Details

I. General information

NPI: 1619821923
Provider Name (Legal Business Name): STEPHANIE JANE RUSSELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE JANE RUSSELL

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2430 BIRD ST
OROVILLE CA
95965-4908
US

IV. Provider business mailing address

6 LAS PLUMAS WAY
OROVILLE CA
95966-6922
US

V. Phone/Fax

Practice location:
  • Phone: 530-552-5058
  • Fax:
Mailing address:
  • Phone: 530-315-2363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: