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General NPI Number Information
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NPI Number | 1083398028
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Entity Type | Organization
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Legal Business Name | DAVID RUSSELL COMPANY
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 1645 PARKHILL DR STE 1
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City | BILLINGS
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State | MT
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Zip | 59102-3067
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Country | US
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Telephone | 406-200-8518
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Fax | 406-794-0206
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Provider Business Mailing Address
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Address Line | PO BOX 23321
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City | BILLINGS
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State | MT
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Zip | 59104-3321
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Country | US
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Telephone | 406-200-8518
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Fax | 406-794-0206
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Authorized Official
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Title or Position | OWNER
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Name | SHANNON DAVID RUSSELL
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Credential | LCPC
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Telephone | 406-200-8518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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