Provider Demographics
NPI:1447307830
Name:RUSSELL, DEBORAH LEE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LEE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 192
Mailing Address - Street 2:
Mailing Address - City:GARRYOWEN
Mailing Address - State:MT
Mailing Address - Zip Code:59031-0192
Mailing Address - Country:US
Mailing Address - Phone:406-638-3491
Mailing Address - Fax:406-638-3431
Practice Address - Street 1:10110 S 7650 E
Practice Address - Street 2:
Practice Address - City:CROW AGENCY
Practice Address - State:MT
Practice Address - Zip Code:59022-0009
Practice Address - Country:US
Practice Address - Phone:406-638-2626
Practice Address - Fax:406-638-3431
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical