Healthcare Provider Details

I. General information

NPI: 1083109011
Provider Name (Legal Business Name): CHELSEA M RUSSELL MS, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N 9TH ST
MONROE LA
71201-5548
US

IV. Provider business mailing address

1011 N 9TH ST
MONROE LA
71201-5548
US

V. Phone/Fax

Practice location:
  • Phone: 318-732-0060
  • Fax: 985-307-4070
Mailing address:
  • Phone: 318-732-0060
  • Fax: 985-307-4070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7075
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number7075
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: