Provider Demographics
NPI:1235836933
Name:RUSSELL, NORMAN CLAY (LAC CCS)
Entity Type:Individual
Prefix:
First Name:NORMAN
Middle Name:CLAY
Last Name:RUSSELL
Suffix:
Gender:M
Credentials:LAC CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7060 PRAIRIE RD # 593
Mailing Address - Street 2:
Mailing Address - City:WINNSBORO
Mailing Address - State:LA
Mailing Address - Zip Code:71295-2951
Mailing Address - Country:US
Mailing Address - Phone:318-805-4775
Mailing Address - Fax:318-435-7063
Practice Address - Street 1:7060 PRAIRIE RD # 593
Practice Address - Street 2:
Practice Address - City:WINNSBORO
Practice Address - State:LA
Practice Address - Zip Code:71295-2951
Practice Address - Country:US
Practice Address - Phone:318-805-4775
Practice Address - Fax:318-435-7063
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1626171M00000X, 101YA0400X, 101YP1600X
LA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral