Healthcare Provider Details

I. General information

NPI: 1447307830
Provider Name (Legal Business Name): DEBORAH LEE RUSSELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10110 S 7650 E
CROW AGENCY MT
59022-0009
US

IV. Provider business mailing address

PO BOX 192
GARRYOWEN MT
59031-0192
US

V. Phone/Fax

Practice location:
  • Phone: 406-638-2626
  • Fax: 406-638-3431
Mailing address:
  • Phone: 406-638-3491
  • Fax: 406-638-3431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number587
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: