Healthcare Provider Details

I. General information

NPI: 1871898882
Provider Name (Legal Business Name): JULIE D RUSSELL MSCP, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2011
Last Update Date: 10/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 CROWE AVE
MARS PA
16046-3303
US

IV. Provider business mailing address

195 CROWE AVE
MARS PA
16046-3303
US

V. Phone/Fax

Practice location:
  • Phone: 724-732-1229
  • Fax: 724-625-4949
Mailing address:
  • Phone: 724-732-1229
  • Fax: 724-625-4949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC005990
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: