Provider Demographics
NPI:1871898882
Name:RUSSELL, JULIE D (MSCP, LPC, NCC)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:D
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MSCP, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 CROWE AVE
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-3303
Mailing Address - Country:US
Mailing Address - Phone:724-732-1229
Mailing Address - Fax:724-625-4949
Practice Address - Street 1:195 CROWE AVE
Practice Address - Street 2:
Practice Address - City:MARS
Practice Address - State:PA
Practice Address - Zip Code:16046-3303
Practice Address - Country:US
Practice Address - Phone:724-732-1229
Practice Address - Fax:724-625-4949
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005990101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional