Provider Demographics
NPI:1235276692
Name:RUSSELL, SARAH HERMANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:HERMANN
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10585 N MERIDIAN ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1069
Mailing Address - Country:US
Mailing Address - Phone:317-580-4002
Mailing Address - Fax:
Practice Address - Street 1:10585 N MERIDIAN ST
Practice Address - Street 2:SUITE 340
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290-1069
Practice Address - Country:US
Practice Address - Phone:317-580-4002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041482A103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling