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General NPI Number Information
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NPI Number | 1376934869
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Entity Type | Individual
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Provider Name | LINDA RUSSELL LCSW
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Gender | Female
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Dates
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Enumeration Date | 02/05/2015
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Last Update Date | 06/06/2017
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Provider Practice Location Address
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Address Line | 3540 S HIGHWAY 27 STE 4
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City | SOMERSET
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State | KY
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Zip | 42501-3124
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Country | US
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Telephone | 606-679-1815
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Fax | 606-451-1631
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Provider Business Mailing Address
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Address Line | 276 GATE RD
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City | RUSSELL SPRINGS
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State | KY
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Zip | 42642-9540
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Country | US
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Telephone | 606-875-4210
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Fax | 606-451-1631
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 252558
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 4626
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License Number State | KY
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