Provider Demographics
NPI:1164841474
Name:ADAMS, RUSSELL PAUL (PH,D)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:PAUL
Last Name:ADAMS
Suffix:
Gender:M
Credentials:PH,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 BELLAGIO DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-5082
Mailing Address - Country:US
Mailing Address - Phone:512-940-4907
Mailing Address - Fax:
Practice Address - Street 1:215 BELLAGIO DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78734-5082
Practice Address - Country:US
Practice Address - Phone:512-940-4907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15071101YP2500X
TX4536106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional