Healthcare Provider Details

I. General information

NPI: 1033028634
Provider Name (Legal Business Name): EDWARD HAMLIN RUSSELL III MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 HENRY CT
LONGMONT CO
80501-2585
US

IV. Provider business mailing address

1522 HENRY CT
LONGMONT CO
80501-2585
US

V. Phone/Fax

Practice location:
  • Phone: 206-651-5758
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: