MEDICARE: MS. ERIN A RUSSELL MS

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	106H00000X	Marriage & Family Therapist	L722	AL

General Provider Information

NPI Number	:	1710747811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ERIN A RUSSELL MS

Provider Business Mailing Address
First Line	:	185 WHITESPORT DR SW STE 5
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35801-6487
Country	:	US
Telephone Number	:	256-880-3500
Fax Number	:	256-880-9203

Provider Business Practice Location Address
First Line	:	11743 COUNTY LINE RD STE C
Second Line	:
City	:	MADISON
State	:	AL
Zip	:	35758-3301
Country	:	US
Telephone Number	:	256-880-3500
Fax Number	:	256-880-9203

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

Provider Enumeration Date	:	03/19/2024
Last Update Date	:	02/02/2026

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