Provider Demographics
NPI:1265842173
Name:RUSSELL, SHEILA (MA, LPC)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:RUSSELL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 SE AVENUE B
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:TX
Mailing Address - Zip Code:79360-4434
Mailing Address - Country:US
Mailing Address - Phone:432-813-0137
Mailing Address - Fax:
Practice Address - Street 1:110 SE AVENUE B
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360-4434
Practice Address - Country:US
Practice Address - Phone:432-813-0137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2019-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69877101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional