Provider Demographics
NPI:1871935197
Name:HODRICK, RUSSELL CLIFFORD
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:CLIFFORD
Last Name:HODRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 F ST NE
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-7917
Mailing Address - Country:US
Mailing Address - Phone:580-465-7045
Mailing Address - Fax:
Practice Address - Street 1:19 F ST NE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-7917
Practice Address - Country:US
Practice Address - Phone:580-465-7045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-28
Last Update Date:2013-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health