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General NPI Number Information
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NPI Number | 1710878525
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Entity Type | Individual
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Provider Name | SARAH RUSSELL LMFT
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Gender | Female
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Dates
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Enumeration Date | 07/10/2025
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Last Update Date | 07/10/2025
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Provider Practice Location Address
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Address Line | 1211 BRUCE GAP RD
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City | CARYVILLE
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State | TN
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Zip | 37714-3921
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Country | US
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Telephone | 423-494-1739
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 375
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City | CARYVILLE
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State | TN
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Zip | 37714-0375
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Country | US
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Telephone | 423-494-1739
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1483
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License Number State | TN
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