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NPI Code Detail

MEDICARE: DANIELLE REBECCA RUSSELL

MEDICARE: DANIELLE REBECCA RUSSELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselorPLC8564LA
2101YM0800XMental Health Counselor010313613LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1101Y00000XOTHERLAPLPC
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1164870226
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIELLE REBECCA RUSSELL
Provider Business Mailing Address
First Line : 3173 WASHINGTON AVE STE B
Second Line :
City : BATON ROUGE
State : LA
Zip : 70802-2178
Country : US
Telephone Number : 252-778-7678
Fax Number : 225-341-6825
Provider Business Practice Location Address
First Line : 3173 WASHINGTON AVE STE B
Second Line :
City : BATON ROUGE
State : LA
Zip : 70802-2178
Country : US
Telephone Number : 225-778-7678
Fax Number : 225-341-6825
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/31/2016
Last Update Date : 04/09/2025

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Directions to “ DANIELLE REBECCA RUSSELL ” Practice Location

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