Provider Demographics
NPI:1225704679
Name:CHRISTINE RUSSO THERAPY PLLC
Entity Type:Organization
Organization Name:CHRISTINE RUSSO THERAPY PLLC
Other - Org Name:RESILIENT ROOTS THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OWNER/ THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LICSW, LMHC
Authorized Official - Phone:509-855-9373
Mailing Address - Street 1:4511 S SHERI CT
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-4456
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:202 E SPOKANE FALLS BLVD STE 302
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1612
Practice Address - Country:US
Practice Address - Phone:509-855-9373
Practice Address - Fax:509-757-2221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty