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General NPI Number Information
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NPI Number | 1588984603
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Entity Type | Individual
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Provider Name | NICHOLAS AARON RUSSELL LPCC
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Gender | Male
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Dates
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Enumeration Date | 06/11/2010
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Last Update Date | 08/16/2023
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Provider Practice Location Address
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Address Line | 1909 CUBA AVE STE 1
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City | ALAMOGORDO
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State | NM
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Zip | 88310-5646
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Country | US
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Telephone | 575-404-1593
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Fax | 575-404-1593
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Provider Business Mailing Address
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Address Line | 3122 SUMMER AVE
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City | ALAMOGORDO
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State | NM
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Zip | 88310-4062
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Country | US
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Telephone | 575-404-1593
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | E0700288S
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | E0700288S
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0206781
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License Number State | NM
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