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General NPI Number Information
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NPI Number | 1699722975
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Entity Type | Individual
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Provider Name | TAMARA LYNNE RUSSELL PSYD
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Gender | Female
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Dates
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Enumeration Date | 05/30/2006
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 4441 DIPLOMACY DR
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City | ANCHORAGE
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State | AK
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Zip | 99508-5910
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Country | US
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Telephone | 907-729-8880
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Fax |
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Provider Business Mailing Address
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Address Line | 7033 E TUDOR RD
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City | ANCHORAGE
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State | AK
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Zip | 99507-1262
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Country | US
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Telephone | 907-729-6799
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Fax | 907-729-5180
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY00003727
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSYP667
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License Number State | AK
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