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General NPI Number Information
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NPI Number | 1588528186
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Entity Type | Individual
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Provider Name | JUAN MIGUEL RUSSIAN
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Gender | Male
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Dates
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Enumeration Date | 12/10/2025
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Last Update Date | 12/10/2025
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Provider Practice Location Address
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Address Line | 3204 LONG PRAIRIE RD STE A
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City | FLOWER MOUND
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State | TX
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Zip | 75022-4958
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Country | US
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Telephone | 903-780-6097
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Fax |
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Provider Business Mailing Address
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Address Line | 1870 RUFE SNOW DR
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City | KELLER
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State | TX
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Zip | 76248-5629
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Country | US
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Telephone | 903-780-6097
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 91083
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License Number State | TX
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