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General NPI Number Information
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NPI Number | 1154924579
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Entity Type | Individual
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Provider Name | CHRISTY MARIE RUSSELL
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Gender | Female
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Dates
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Enumeration Date | 11/18/2020
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 908 5TH AVE SE
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City | OLYMPIA
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State | WA
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Zip | 98501-1507
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Country | US
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Telephone | 360-878-4809
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Fax |
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Provider Business Mailing Address
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Address Line | 503 V ST SE
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City | TUMWATER
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State | WA
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Zip | 98501-5347
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Country | US
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Telephone | 360-995-3585
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | CG61325552
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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