Healthcare Provider Details

I. General information

NPI: 1245190867
Provider Name (Legal Business Name): MARINA JUNE RUSSELL AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2025
Last Update Date: 11/15/2025
Certification Date: 11/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 INDUSTRIAL ST
REDDING CA
96002-0734
US

IV. Provider business mailing address

10141 ROAD RUNNER WAY
REDDING CA
96003-9661
US

V. Phone/Fax

Practice location:
  • Phone: 530-722-9957
  • Fax:
Mailing address:
  • Phone: 530-722-9957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT158885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: