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General NPI Number Information
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NPI Number | 1417560806
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Entity Type | Individual
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Provider Name | RUSSELL PRAUSE MS, LPC-S
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Gender | Male
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Dates
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Enumeration Date | 08/26/2020
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Last Update Date | 01/20/2026
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Provider Practice Location Address
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Address Line | 14800 W MOUNTAIN VIEW BLVD STE 210
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City | SURPRISE
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State | AZ
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Zip | 85374-2703
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Country | US
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Telephone | 623-888-4310
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Fax |
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Provider Business Mailing Address
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Address Line | 701 NW MCNELLY RD STE 9
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City | BENTONVILLE
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State | AR
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Zip | 72712-9160
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Country | US
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Telephone | 623-888-4310
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 20565
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License Number State | AZ
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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 | P2501015
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LPC-20565
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License Number State | AZ
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