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General NPI Number Information
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NPI Number | 1215149588
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Entity Type | Individual
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Provider Name | BARBARA J DUBOIS RUSSELL ED.D, LMHC, NCC
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Gender | Female
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 01/27/2012
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Provider Practice Location Address
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Address Line | 2925 CANOE CREEK RD
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City | SAINT CLOUD
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State | FL
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Zip | 34772-6504
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Country | US
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Telephone | 407-552-7339
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Fax | 407-891-2175
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Provider Business Mailing Address
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Address Line | 4485 BRADY RD
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City | SAINT CLOUD
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State | FL
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Zip | 34772
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Country | US
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Telephone | 407-552-7339
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Fax | 407-891-2175
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH8825
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License Number State | FL
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