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General NPI Number Information
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NPI Number | 1669337499
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Entity Type | Individual
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Provider Name | SYDNEE RUSS
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Gender | Female
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Dates
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Enumeration Date | 12/23/2025
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Last Update Date | 12/23/2025
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Provider Practice Location Address
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Address Line | 107 N 3RD AVE
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City | DURANT
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State | OK
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Zip | 74701-4700
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Country | US
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Telephone | 580-706-6936
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Fax |
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Provider Business Mailing Address
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Address Line | 200 CHOCTAW EST CIR
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City | SHERMAN
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State | TX
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Zip | 75092-6972
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Country | US
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Telephone | 469-925-5450
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | BACB1490996
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License Number State | TX
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