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General NPI Number Information
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NPI Number | 1588286504
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Entity Type | Organization
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Legal Business Name | LORI RUSSELL-SIEMER LLC
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Dates
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Enumeration Date | 05/13/2020
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Last Update Date | 05/13/2020
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Provider Practice Location Address
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Address Line | 1703 PEYCO DR N STE L
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City | ARLINGTON
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State | TX
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Zip | 76001-6701
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Country | US
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Telephone | 817-854-4991
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Fax |
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Provider Business Mailing Address
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Address Line | 1930 SANTA ANNA DR
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City | ARLINGTON
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State | TX
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Zip | 76001-5611
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Country | US
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Telephone | 817-706-1728
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LORI RUSSELL-SIEMER
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Credential | LCSW
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Telephone | 817-706-1728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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