Provider Demographics
NPI:1205856283
Name:RUSSELL, CHRISTINA LOUISE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:LOUISE
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10615 PERRIN BEITEL RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-3138
Mailing Address - Country:US
Mailing Address - Phone:210-490-9106
Mailing Address - Fax:
Practice Address - Street 1:10615 PERRIN BEITEL RD
Practice Address - Street 2:SUITE 207
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-3138
Practice Address - Country:US
Practice Address - Phone:210-490-9106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17708101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
84990LOtherBCBS
205127458OtherEIN