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General NPI Number Information
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NPI Number | 1487203485
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Entity Type | Individual
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Provider Name | MATTHEW E.B. RUSSELL PHD
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Gender | Male
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Dates
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Enumeration Date | 09/11/2019
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 1504 BEN TAUB LOOP
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City | HOUTON
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State | TX
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Zip | 77030
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Country | US
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Telephone | 713-873-2000
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Fax |
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Provider Business Mailing Address
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Address Line | 2650 RIDGE AVE STE 1223
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City | EVANSTON
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State | IL
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Zip | 60201-1700
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Country | US
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Telephone |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 38283
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License Number State | TX
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