MEDICARE: DELISA DUNCAN RUSSELL LPC-S

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
1	101YM0800X	Mental Health Counselor	15324	TX
2	101YP2500X	Professional Counselor	15324	TX
3	101Y00000X	Counselor	15324	TX

Other Identifiers

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

General Provider Information

NPI Number	:	1568501187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELISA DUNCAN RUSSELL LPC-S

Provider Business Mailing Address
First Line	:	5 OTTER POND PL
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77381-4011
Country	:	US
Telephone Number	:	210-725-7716
Fax Number	:

Provider Business Practice Location Address
First Line	:	147 W SUNSET RD STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-2681
Country	:	US
Telephone Number	:	210-725-7716
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	01/28/2026

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