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NPI Code Detail

MEDICARE: BETTY GRACE RUSSELL LCSW

MEDICARE:   BETTY GRACE RUSSELL  LCSW
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
1101YM0800XMental Health CounselorC-12165NM
2101YM0800XMental Health Counselor7437-CNV
3104100000XSocial Worker6120-SNV

General Provider Information

NPI Number : 1801209267
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETTY GRACE RUSSELL LCSW
Provider Business Mailing Address
First Line : 901 N JONES BLVD UNIT 213
Second Line :
City : LAS VEGAS
State : NV
Zip : 89108-1603
Country : US
Telephone Number : 702-626-3230
Fax Number :
Provider Business Practice Location Address
First Line : 901 N JONES BLVD UNIT 213
Second Line :
City : LAS VEGAS
State : NV
Zip : 89108-1603
Country : US
Telephone Number : 702-626-3230
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2014
Last Update Date : 01/06/2023

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Directions to “ BETTY GRACE RUSSELL LCSW” Practice Location

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