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General NPI Number Information
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NPI Number | 1851916852
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Entity Type | Organization
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Legal Business Name | RUSSELL PSYCHOLOGICAL CORP.
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Dates
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Enumeration Date | 06/15/2020
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Last Update Date | 07/08/2020
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Provider Practice Location Address
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Address Line | 520 S GRAND AVE STE 671
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City | LOS ANGELES
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State | CA
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Zip | 90071-2655
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Country | US
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Telephone | 323-446-2820
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Fax |
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Provider Business Mailing Address
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Address Line | 520 S GRAND AVE STE 671
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City | LOS ANGELES
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State | CA
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Zip | 90071-2655
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Country | US
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Telephone | 323-446-2820
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Fax |
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. MATTHEW RUSSELL
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Credential | PSYD
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Telephone | 323-446-2820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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