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NPI Code Detail

MEDICARE: RUSSELL PSYCHIATRY, PROFESSIONAL LIMITED LIABILITY COMPANY

MEDICARE: RUSSELL PSYCHIATRY, PROFESSIONAL LIMITED LIABILITY COMPANY
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
12084P0800XPsychiatry PhysicianQ6697TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11275945511OTHERTXNPI DR. STACEY RUSSELL

General Provider Information

NPI Number : 1356846729
Entity Type Code : Organization
Provider Name (Legal Business Name) : RUSSELL PSYCHIATRY, PROFESSIONAL LIMITED LIABILITY COMPANY
Provider Business Mailing Address
First Line : 2006 S LOOP 336 W STE 500
Second Line :
City : CONROE
State : TX
Zip : 77304-3315
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2006 S LOOP 336 W STE 500
Second Line :
City : CONROE
State : TX
Zip : 77304-3315
Country : US
Telephone Number : 817-726-9444
Fax Number :
Authorized Official
Title or Position : MANAGER/LEAD PSYCHIATRIST
Name : DR. STACEY RUSSELL
Credential : MD
Telephone Number : 817-726-9444
Provider Enumeration Date : 03/28/2018
Last Update Date : 03/28/2018

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Directions to “RUSSELL PSYCHIATRY, PROFESSIONAL LIMITED LIABILITY COMPANY ” Practice Location

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