Healthcare Provider Details

I. General information

NPI: 1154644474
Provider Name (Legal Business Name): BRANDY R RUSSELL MS, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10552 SUCCESS LN STE G
DAYTON OH
45458-3653
US

IV. Provider business mailing address

2707 ALLISTER CIR
MIAMISBURG OH
45342-5859
US

V. Phone/Fax

Practice location:
  • Phone: 937-204-3647
  • Fax: 937-791-6686
Mailing address:
  • Phone: 937-204-3647
  • Fax: 937-791-6686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberE.0701142
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: