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General NPI Number Information
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NPI Number | 1235836933
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Entity Type | Individual
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Provider Name | NORMAN CLAY RUSSELL LAC CCS
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Gender | Male
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Dates
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Enumeration Date | 02/13/2023
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Last Update Date | 02/13/2023
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Provider Practice Location Address
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Address Line | 7060 PRAIRIE RD # 593
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City | WINNSBORO
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State | LA
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Zip | 71295-2951
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Country | US
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Telephone | 318-805-4775
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Fax | 318-435-7063
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Provider Business Mailing Address
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Address Line | 7060 PRAIRIE RD # 593
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City | WINNSBORO
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State | LA
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Zip | 71295-2951
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Country | US
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Telephone | 318-805-4775
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Fax | 318-435-7063
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 1626
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1626
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 101YP1600X
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Taxonomy Name | Pastoral Counselor
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License Number | 1626
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License Number State | LA
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