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General NPI Number Information
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NPI Number | 1528914819
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Entity Type | Individual
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Provider Name | DEMETRIA RUSSELL LPC
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Gender | Female
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Dates
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Enumeration Date | 03/09/2026
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Last Update Date | 03/09/2026
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Provider Practice Location Address
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Address Line | 3957 JOST FARM WAY
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City | FLORISSANT
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State | MO
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Zip | 63034-2250
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Country | US
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Telephone | 314-226-8668
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Fax |
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Provider Business Mailing Address
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Address Line | 3957 JOST FARM WAY
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City | FLORISSANT
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State | MO
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Zip | 63034-2250
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Country | US
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Telephone | 314-226-8668
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number |
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License Number State |
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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 | 2024009989
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License Number State | MO
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