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General NPI Number Information
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NPI Number | 1578570305
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Entity Type | Individual
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Provider Name | ANITA JEANNE RUSSELL ED.D.
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Gender | Female
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 10/27/2011
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Provider Practice Location Address
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Address Line | 3314 E 51ST ST SUITE 204F
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City | TULSA
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State | OK
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Zip | 74135-3583
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Country | US
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Telephone | 918-671-7960
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Fax | 918-728-8387
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Provider Business Mailing Address
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Address Line | 4203 E 75TH PL
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City | TULSA
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State | OK
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Zip | 74136-6126
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Country | US
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Telephone | 918-671-7960
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Fax | 918-728-8387
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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 | 632
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License Number State | OK
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