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General NPI Number Information
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NPI Number | 1649394008
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Entity Type | Individual
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Provider Name | RALPH J RUSSELL LCSW
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Gender | Male
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 02/01/2008
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Provider Practice Location Address
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Address Line | RR 1 BOX 67
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City | HARLEM
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State | MT
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Zip | 59526-9705
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Country | US
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Telephone | 406-353-3100
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Fax | 406-353-3229
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Provider Business Mailing Address
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Address Line | 319 9TH AVE
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City | HAVRE
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State | MT
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Zip | 59501-3754
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Country | US
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Telephone | 406-353-3162
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Fax | 406-353-3308
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 175 LCSW
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License Number State | MT
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