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General NPI Number Information
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NPI Number | 1578885810
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Entity Type | Individual
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Provider Name | RUSSELL CRUSE LPCC-S
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Gender | Male
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Dates
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Enumeration Date | 02/26/2010
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 9475 KENWOOD RD STE 13
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City | BLUE ASH
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State | OH
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Zip | 45242-6830
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Country | US
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Telephone | 513-535-3653
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Fax | 513-586-0998
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Provider Business Mailing Address
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Address Line | 562 GARNER DR
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City | COVINGTON
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State | KY
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Zip | 41015-2323
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Country | US
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Telephone | 513-520-0252
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Fax | 513-586-0998
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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 | E0007705
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License Number State | OH
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